المؤلفون: Bushra Jamil, Divya Nair, Pruthu Thekkur, Neelofar Laeeq, Anum Adil, Mohammed Khogali, Rony Zachariah, Selma Dar Berger, Srinath Satyanarayana, Ajay M V Kumar, Aaron Bochner, Amanda McClelland, Razia Fatima, Anthony D Harries

المصدر: PLoS ONE, Vol 18, Iss 12, p e0295580 (2023)

مصطلحات موضوعية: Medicine, Science

الوصف: IntroductionScreening household contacts of TB patients and providing TB preventive therapy (TPT) is a key intervention to end the TB epidemic. Global and timely implementation of TPT in household contacts, however, is dismal. We adapted the 7-1-7 timeliness metric designed to evaluate and respond to infectious disease outbreaks or pandemics, and assessed the feasibility, enablers and challenges of implementing this metric for screening and management of household contacts of index patients with bacteriologically-confirmed pulmonary TB in Karachi city, Pakistan.MethodsWe conducted an explanatory mixed methods study with a quantitative component (cohort design) followed by a qualitative component (descriptive design with focus group discussions).ResultsFrom January-June 2023, 92% of 450 index patients had their household contacts line-listed within seven days of initiating anti-TB treatment ("first 7"). In 84% of 1342 household contacts, screening outcomes were ascertained within one day of line-listing ("next 1"). In 35% of 256 household contacts eligible for further evaluation by a medical officer (aged ≤5 years or with chest symptoms), anti-tuberculosis treatment, TPT or a decision for no drugs was made within seven days of symptom screening ("second 7"). The principal reason for not starting anti-tuberculosis treatment or TPT was failure to consult a medical officer: only 129(50%) of 256 contacts consulted a medical officer. Reasons for poor performance in the "second 7" component included travel costs to see a medical officer, loss of daily earnings and fear of a TB diagnosis. Field staff reported that timeliness metrics motivated them to take prompt action in household contact screening and TPT provision and they suggested these be included in national guidelines.ConclusionsField staff found "7-1-7" timeliness metrics to be feasible and useful. Integration of these metrics into national guidelines could improve timeliness of diagnosis, treatment and prevention of TB within households of index patients.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/a62f78fce5e74bb6839282fcc3c469d0

المؤلفون: Ndaimani Augustine, Owiti Philip, Ajay M V Kumar, Zizhou Simukai, Mugurungi Owen, Mugauri Hamufare Dumisani, Komtenza Brian

المصدر: Journal of Global Infectious Diseases, Vol 13, Iss 2, Pp 72-79 (2021)

مصطلحات موضوعية: cotrimoxazole prophylaxis, early infant diagnosis, human immunodeficiency virus-exposed infants, operational research, record-based study, structured operational research and training initiative, vertical human immunodeficiency virus transmission cascade, Infectious and parasitic diseases, RC109-216

الوصف: Introduction: Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017. Methods: This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression). Results: Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months. Conclusions: While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.

وصف الملف: electronic resource

Relation: http://www.jgid.org/article.asp?issn=0974-777X;year=2021;volume=13;issue=2;spage=72;epage=79;aulast=Augustine; https://doaj.org/toc/0974-777X

URL الوصول: https://doaj.org/article/a704277018cd425f8c8fdb70643d6c42

المؤلفون: Khine Wut Yee Kyaw, Nang Thu Thu Kyaw, Myo Su Kyi, Sandar Aye, Anthony D Harries, Ajay M V Kumar, Nay Lynn Oo, Srinath Satyanarayana, Si Thu Aung

المصدر: PLoS ONE, Vol 15, Iss 6, p e0234429 (2020)

مصطلحات موضوعية: Medicine, Science

الوصف: IntroductionThe World Health Organization's framework for TB/HIV collaborative activities recommends provider-initiated HIV testing and counselling (PITC) of patients with presumptive TB. In Myanmar, PITC among presumptive TB patients was started at the TB outpatient department (TB OPD) in Mandalay in 2014. In this study, we assessed the uptake of PITC among presumptive TB patients and the number needed to screen to find one additional HIV positive case, stratified by demographic and clinical characteristics.MethodThis was a cross-sectional study using routinely collected data of presumptive TB patients who registered for PITC services at the TB OPD between August 2014 and December 2017 in Mandalay.ResultAmong 21,989 presumptive TB patients registered, 9,796 (44.5%) had known HIV status at registration and 2,763 (28.2%) were people already living with HIV (PLHIV). Of the remainder, 85.3% (10,401/12,193) were newly tested for HIV. Patients ConclusionUptake of HIV testing among eligible presumptive TB patients was high with four out of five presumptive TB patients being tested for HIV. This strategy detected many additional HIV-positive persons, and this included those who were not diagnosed with TB. We strongly recommend that this strategy be implemented nationwide in Myanmar.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/0d56512f51e64de0ad381ae5bff51b3b

المؤلفون: Mitasha Singh, Vishal Dogra, Ravinder Kumar, Ajay M V Kumar

المصدر: Journal of the Scientific Society, Vol 44, Iss 1, Pp 26-30 (2017)

مصطلحات موضوعية: Global Adult Tobacco Survey, loose cigarettes, raising taxes, smoking, Medicine

الوصف: Context: Raising tax on tobacco products is one of the key tobacco control strategies. Globally, it has led to decrease in overall cigarette consumption but on the other hand contributed to increased sale and purchase of loose cigarettes. These loose cigarettes have many important public health implications. Aim: To assess the association between practice of buying loose cigarettes and intensity of smoking. Materials and Methods: A secondary analysis of Global Adult Tobacco Survey, India 2009–2010 data was performed in May 2014, on adult population age 15 years and above. The key outcome variable was “intensity of smoking” defined as average number of cigarettes smoked per day, whereas the key exposure variable was “practice of purchasing loose cigarettes.” Descriptive statistical analysis was performed using EpiData software (version 2.2.2.182) and STATA version 12.1. Results: Nearly, 57% of current cigarette smokers (approximately 3.46 million) bought loose cigarettes. The proportion of buying loose cigarettes decreased with increasing level of education and wealth index as well as least among government employees. The intensity of smoking was 70% less among loose cigarette buyers than nonbuyers (odds ratio [OR]: 0.29, 95% confidence interval [CI]: 0.24–0.34). It was found to be significantly lower in rural areas (OR: 0.81, 95% CI: 0.68–0.97) and among homemakers and those who had formal schooling. Conclusion: This study showed that loose cigarette buying is associated with decreased in smoking intensity. This may be due to increased taxes leading to increased buying of single cigarettes. These findings, therefore, highlight a need for a comprehensive policy and further studies on loose cigarette selling.

وصف الملف: electronic resource

Relation: http://www.jscisociety.com/article.asp?issn=0974-5009;year=2017;volume=44;issue=1;spage=26;epage=30;aulast=Singh; https://doaj.org/toc/0974-5009

URL الوصول: https://doaj.org/article/24d15cf3a2ee4abe9135754fc52bcffe

المؤلفون: Hemant Deepak Shewade, Vivek Gupta, Srinath Satyanarayana, Prabhat Pandey, U N Bajpai, Jaya Prasad Tripathy, Soundappan Kathirvel, Sripriya Pandurangan, Subrat Mohanty, Vaibhav Haribhau Ghule, Karuna D Sagili, Banuru Muralidhara Prasad, Sudhi Nath, Priyanka Singh, Kamlesh Singh, Ramesh Singh, Gurukartick Jayaraman, P Rajeswaran, Binod Kumar Srivastava, Moumita Biswas, Gayadhar Mallick, Om Prakash Bera, K N Sahai, Lakshmi Murali, Sanjeev Kamble, Madhav Deshpande, Naresh Kumar, Sunil Kumar, A James Jeyakumar Jaisingh, Ali Jafar Naqvi, Prafulla Verma, Mohammed Salauddin Ansari, Prafulla C Mishra, G Sumesh, Sanjeeb Barik, Vijesh Mathew, Manas Ranjan Singh Lohar, Chandrashekhar S Gaurkhede, Ganesh Parate, Sharifa Yasin Bale, Ishwar Koli, Ashwin Kumar Bharadwaj, G Venkatraman, K Sathiyanarayanan, Jinesh Lal, Ashwini Kumar Sharma, Raghuram Rao, Ajay M V Kumar, Sarabjit Singh Chadha

المصدر: PLoS ONE, Vol 14, Iss 3, p e0213345 (2019)

مصطلحات موضوعية: Medicine, Science

الوصف: BackgroundAxshya SAMVAD is an active tuberculosis (TB) case finding (ACF) strategy under project Axshya (Axshya meaning 'free of TB' and SAMVAD meaning 'conversation') among marginalized and vulnerable populations in 285 districts of India.ObjectivesTo compare patient characteristics, health seeking, delays in diagnosis and treatment initiation among new sputum smear positive TB patients detected through ACF and passive case finding (PCF) under the national TB programme in marginalized and vulnerable populations between March 2016 and February 2017.MethodsThis observational analytic study was conducted in 18 randomly sampled Axshya districts. We enrolled all TB patients detected through ACF and an equal number of randomly selected patients detected through PCF in the same settings. Data on patient characteristics, health seeking and delays were collected through record review and patient interviews (at their residence). Delays included patient level delay (from eligibility for sputum examination to first contact with any health care provider (HCP)), health system level diagnosis delay (from contact with first HCP to TB diagnosis) and treatment initiation delays (from diagnosis to treatment initiation). Total delay was the sum of patient level, health system level diagnosis delay and treatment initiation delays.ResultsWe included 234 ACF-diagnosed and 231 PCF-diagnosed patients. When compared to PCF, ACF patients were relatively older (≥65 years, 14% versus 8%, p = 0.041), had no formal education (57% versus 36%, pConclusionAxshya SAMVAD linked the most impoverished communities to TB care and resulted in reduction of health system level diagnosis delay.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/02e6a41f36664ba89bdb2fc739485a2f

المؤلفون: Hemant Deepak Shewade, Arun M Kokane, Akash Ranjan Singh, Malik Parmar, Manoj Verma, Prabha Desikan, Sheeba Naz Khan, Ajay M V Kumar

المصدر: PLoS ONE, Vol 13, Iss 4, p e0196162 (2018)

مصطلحات موضوعية: Medicine, Science

الوصف: BACKGROUND:In a study conducted in Bhopal district (a setting with facility for molecular drug susceptibility testing (DST)) located in central India in 2014-15, we found high levels of pre-diagnosis attrition among patients with presumptive multi drug-resistant tuberculosis (MDR-TB)-meaning TB patients who were eligible for DST, were not being tested. OBJECTIVES:In this study, we explored the health care provider perspectives into barriers and suggested solutions for improving DST. METHODS:This was a descriptive qualitative study. One to one interviews (n = 10) and focus group discussions (n = 2) with experienced key informants involved in programmatic management of DR-TB were conducted in April 2017. Manual descriptive thematic analysis was performed. RESULTS:The key barriers reported were a) lack of or delay in identification of patients eligible for DST because of using treatment register as the source for identifying patients b) lack of assured specimen transport after patient identification and c) lack of tracking. Extra pulmonary TB patients were not getting identified as eligible for DST. Solutions suggested by the health care providers were i) generation of unique identifier at identification in designated microscopy center (DMC), immediate intimation of unique identifier to district and regular monitoring by senior TB laboratory and senior treatment supervisors of patients eligible for DST that were missed; ii) documentation of unique identifier at each step of cascade; iii) use of human carriers/couriers to transport specimen from DMCs especially in rural areas; and iv) routine entry of all presumptive extra-pulmonary TB specimen, as far as possible, in DMC laboratory register. CONCLUSION:Lack of assured specimen transport and lack of accountability for tracking patient after identification and referral were the key barriers. The identification of patients eligible for DST among microbiologically confirmed TB at the time of diagnosis and among clinically confirmed TB at the time of treatment initiation is the key. Use of unique identifier at identification and its use to ensure cohort wise tracking has to be complemented with specimen transport support and prompt feedback to the DMC. The study has implications to improve detection of MDR-TB among diagnosed/notified TB patients.

وصف الملف: electronic resource

Relation: http://europepmc.org/articles/PMC5909888?pdf=render; https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/381d4df1a588415ab251c149637b84cc

المؤلفون: Karuna D Sagili, Srinath Satyanarayana, Sarabjit S Chadha, Nevin C Wilson, Ajay M V Kumar, Patrick K Moonan, John E Oeltmann, Vineet K Chadha, Sharath Burugina Nagaraja, Smita Ghosh, Terrence Q Lo, Tyson Volkmann, Matthew Willis, Kalpita Shringarpure, Ravichandra Chinnappa Reddy, Prahlad Kumar, Sreenivas A Nair, Raghuram Rao, Mohammed Yassin, Perry Mwangala, Rony Zachariah, Jamhoih Tonsing, Anthony D Harries, Sunil Khaparde

المصدر: Global Health Action, Vol 11, Iss 1 (2018)

مصطلحات موضوعية: operational research (OR), implementation research, Global Fund project, Tuberculosis (TB), India, Public aspects of medicine, RA1-1270

الوصف: Background: The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. Objectives: To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. Methods: From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project’s core activities and outcomes. Results: In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. Conclusions: OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1654-9716; https://doaj.org/toc/1654-9880

URL الوصول: https://doaj.org/article/7dcafd84c6084d4d88aaa6a44c0a67fb

المؤلفون: Nang Thu Thu Kyaw, Anthony D Harries, Ajay M V Kumar, Myo Minn Oo, Khine Wut Yee Kyaw, Than Win, Thet Ko Aung, Aung Chan Min, Htun Nyunt Oo

المصدر: PLoS ONE, Vol 12, Iss 2, p e0171780 (2017)

مصطلحات موضوعية: Medicine, Science

الوصف: BACKGROUND:The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC). METHODS:Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes. RESULTS:Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART. CONCLUSIONS:We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing.

وصف الملف: electronic resource

Relation: http://europepmc.org/articles/PMC5300167?pdf=render; https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/37a6e86bb4be430c9a78672a6cc6dca6

المؤلفون: Hemant Deepak Shewade, Kathiresan Jeyashree, Preetam Mahajan, Amar N Shah, Richard Kirubakaran, Raghuram Rao, Ajay M V Kumar

المصدر: PLoS ONE, Vol 12, Iss 10, p e0186697 (2017)

مصطلحات موضوعية: Medicine, Science

الوصف: Stringent glycemic control by using insulin as a replacement or in addition to oral hypoglycemic agents (OHAs) has been recommended for people with tuberculosis and diabetes mellitus (TB-DM). This systematic review (PROSPERO 2016:CRD42016039101) analyses whether this improves TB treatment outcomes.Among people with drug-susceptible TB and DM on anti-TB treatment, to determine the effect of i) glycemic control (stringent or less stringent) compared to poor glycemic control and ii) insulin (only or with OHAs) compared to 'OHAs only' on unsuccessful TB treatment outcome(s). We looked for unfavourable TB treatment outcomes at the end of intensive phase and/or end of TB treatment (minimum six months and maximum 12 months follow up). Secondary outcomes were development of MDR-TB during the course of treatment, recurrence after 6 months and/or after 1 year post successful treatment completion and development of adverse events related to glucose lowering treatment (including hypoglycemic episodes).All interventional studies (with comparison arm) and cohort studies on people with TB-DM on anti-TB treatment reporting glycemic control, DM treatment details and TB treatment outcomes were eligible. We searched electronic databases (EMBASE, PubMed, Google Scholar) and grey literature between 1996 and April 2017. Screening, data extraction and risk of bias assessment were done independently by two investigators and recourse to a third investigator, for resolution of differences.After removal of duplicates from 2326 identified articles, 2054 underwent title and abstract screening. Following full text screening of 56 articles, nine cohort studies were included. Considering high methodological and clinical heterogeneity, we decided to report the results qualitatively and not perform a meta-analysis. Eight studies dealt with glycemic control, of which only two were free of the risk of bias (with confounder-adjusted measures of effect). An Indian study reported 30% fewer unsuccessful treatment outcomes (aOR (0.95 CI): 0.72 (0.64-0.81)) and 2.8 times higher odds of 'no recurrence' (aOR (0.95 CI): 2.83 (2.60-2.92)) among patients with optimal glycemic control at baseline. A Peruvian study reported faster culture conversion among those with glycemic control (aHR (0.95 CI): 2.2 (1.1,4)). Two poor quality studies reported the effect of insulin on TB treatment outcomes.We identified few studies that were free of the risk of bias. There were limited data and inconsistent findings among available studies. We recommend robustly designed and analyzed studies including randomized controlled trials on the effect of glucose lowering treatment options on TB treatment outcomes.

وصف الملف: electronic resource

Relation: http://europepmc.org/articles/PMC5653348?pdf=render; https://doaj.org/toc/1932-6203

URL الوصول: https://doaj.org/article/c53c5c54c80c463c81ea7a3ec4ad2b33

المؤلفون: Christian Lienhardt, Knut Lönnroth, Dick Menzies, Manica Balasegaram, Jeremiah Chakaya, Frank Cobelens, Jennifer Cohn, Claudia M Denkinger, Thomas G Evans, Gunilla Källenius, Gilla Kaplan, Ajay M V Kumar, Line Matthiessen, Charles S Mgone, Valerie Mizrahi, Ya-Diul Mukadi, Viet Nhung Nguyen, Anders Nordström, Christine F Sizemore, Melvin Spigelman, S Bertel Squire, Soumya Swaminathan, Paul D Van Helden, Alimuddin Zumla, Karin Weyer, Diana Weil, Mario Raviglione

المصدر: PLoS Medicine, Vol 13, Iss 3, p e1001965 (2016)

مصطلحات موضوعية: Medicine

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1549-1277; https://doaj.org/toc/1549-1676

URL الوصول: https://doaj.org/article/56795b672f764a11bdfbae85e33b193f