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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Tuberculosis (TB) treatment outcomes in adult TB patients attending a rural HIV cllinic in South Africa (Bushbuckridge).

Mashimbye, Lawrence 14 April 2010 (has links)
MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, 2009 / South Africa is ranked fourth on the list of 22 high-burden TB countries in the world. Intensifying the prevalence of TB in South Africa is the high TB/HIV co-infection rate, with 44% of new TB patients testing positive for HIV. This burden is intense for rural communities due to poverty and return of people with TB/HIV co-infection who previously migrated for employment. In rural South Africa, TB is the leading cause of mortality in HIV-infected persons, but limited information is available about predictors of death. This study measures TB treatment outcomes in Rixile clinic and assesses predictors of TB mortality. Rixile HIV clinic is based in Tintswalo hospital, Acornhoek, Bushbuckridge, Mpumalanga province. This current study uses secondary data collected through a prospective cohort study conducted by PHRU and RADAR from March 2003 to March 2008 on 3 to 6 monthly intervals. Chi-square and logistic regression statistical tests were used to assess predictors of TB Mortality. TB mortality among study participants was 62.5% during the pre-ARV rollout period (March 2003- October 2005), and treatment completion was 31.7%. Some 5.8% participants interrupted treatment during the pre-ARV rollout period as compared to 4.5% during the ARV rollout period (November 2005- March 2008). TB mortality among study participants was 7.5% during ARV rollout and treatment completion increased to 84.4%. Factors associated with TB mortality were age (p=0.006), sex (p=0.017), BMI (p< 0.001), marital status (p=0.004), education (p=0.03), alcoholic beverages consumption (p=0.04), and ARV treatment (p<0.001). However, only age, sex, and ARV treatment were found to predict TB mortality. The proportion of TB treatment completion was higher and TB mortality was lower during ARV roll-out compared to pre-ARV roll-out. Being at the age of 40 to 75 years, not being on ARV treatment and male sex predicts TB mortality in this population. There is a need to expand ARV treatment and intensify TB care services for older people, particularly males living with HIV in this rural community.
2

Patient experiences and perceptions of non-compliance with TB treatment

Shasha, Alethea Christina N. 03 1900 (has links)
Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Non-compliance with (tuberculosis) TB treatment is a problem at the Nyanga Clinic in the Western Cape Province. Non-compliance is defined as when a patient interrupted TB treatment for more than two months consecutively, at any time during the treatment period. The aim of the study was to explore the patient experiences and perceptions of non-compliance regarding their TB treatment. The following research question was posed by the researcher as a guide for this study: “What are the patient experiences and perceptions of non-compliance with TB treatment?” The objectives of this study were to determine the: - patients’ experiences and perceptions of non-compliance with TB treatment - non-compliant patients’ knowledge regarding TB - reasons why patients are not compliant with TB treatment. A qualitative, explorative, descriptive and contextual design was applied. The target population included the 354 non-compliant with TB treatment patients from March 2010 until May 2011. A purposive, non-random sampling technique was used to select participants for the study. Every tenth participant who, according to the TB register, was colour-coded as non-compliant with TB treatment, was selected for interviewing until data saturation should occurred. A sample of fourteen (14) participants was realised. A semi-structured interview schedule was developed based on the objectives of the study, which was validated by experts in nursing and approved by the Human Resources Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch. Data was collected personally by the researcher. Informed written consent was obtained from the participants. One patient who was not included in the main study was selected at random to pre-test the semi-structured interview. The pilot study revealed no pitfalls. Trustworthiness of the research was enhanced by adhering to the principles of credibility, confirmability, transferability and dependability. Credibility was ensured by member checking, data saturation, triangulation and involvement of an experienced research supervisor. Confirmability was enhanced through member checking and the leaving of an audit trail. Transferability through keeping an intensive description of all the processes and dependability by using an interview schedule and by submitting the transcribed tape-recorded data and field notes to the research supervisor for verification. The quantitative data was summarised in a table format to enhance clarity and facilitate a rapid overview of the results. The qualitative data was analysed manually with the findings coded and divided into subthemes and themes. Four themes emerged, namely: health system, client-related, social-economic and therapy factors. These themes identified the impeding factors regarding the non-compliance with TB treatment. The main conclusion is that there is a need to educate the community regarding the lengthy duration of the TB treatment, its side-effects, its curability and the spread of the infection as well as the consequences of inadequate treatment to empower the community at large about the disease. The National Department of Health framework of contributing to non-compliance with TB treatment was used as the conceptual framework for this study. The researcher applied the problem-solving approach of Faye Glen Abdellah’s theory. According to this theory it is anticipated that by solving the problems or needs of patients, through appropriate and organised health strategies the client will be moved towards ultimate health. / AFRIKAANSE OPSOMMING: Onderbreking van tuberkulose (TB) behandeling is ’n probleem by die Nyanga-kliniek in die Wes-Kaap Provinsie. Onderbreking kan gedefinieer word wanneer’n pasiënt vir twee of drie opeenvolgende maande TB behandeling onderbreek het (Jaggarajamma, Sudha, Chandrasekaran, Nirupa, Thomas, Santha, Muniyandi & Narayanan, 2007:131). Die doel van die studie is om die pasiënte se ervaringe en persepsies betreffende die onderbreking in TB behandeling te ondersoek. Die navorser het die volgende navorsingsvraag as riglyn vir hierdie studie gestel: “Wat is die pasiënte se ervaringe en persepsies wat TB-behandeling onderbreek het?” Die doelwitte van die studie was om te bepaal wat die: - pasiëntervaringe en persepsies is wat TB-behandeling onderbreek - kennis van pasiënte is wat TB-behandeling onderbreek - redes is waarom pasiënte TB-behandeling onderbreek. ’n Kwalitatiewe navorsingsontwerp met’n ondersoekende, beskrywende en kontekstuele benadering is aangewend. ’n Doelbewuste, lukrake steekproef is gebruik om deelnemers te selekteer. ‘n Steekproef van veertien (14) deelnemers uit ’n totale populasie van 354 hetrealiseer en sluit pasiënte in wat behandeling onderbreek het vanaf Maart 2010 tot en met Mei 2011. ’n Semi-gestruktureerde onderhoudsgids is ontwerp, gebaseer op die doelwitte van die studie en gevalideer deur kundiges in verpleegkunde en die Etiese Komitee van die Fakulteit van Gesondheidswetenskappe aan die Universiteit van Stellenbosch. Die data is persoonlik deur die navorser ingesamel. Ingeligte skriftelike toestemming is van die deelnemers verkry. Een deelnemer wat nie ingesluit is by die hoofstudie nie, is lukraak gekies om die semi-gestruktureerde onderhoud te toets. Die loodsondersoek het geen tekortkominge aangedui nie. Betroubaarheid van die studie is verseker deur die beginsels van objektiwiteit, bevestiging, veralgemening en neutraliteit te verseker. Getranskribeerde data is gekontroleer met die deelnemers, volledige beskrywings van alle prosesse is bygehou, ’n onderhoudsgids is gebruik om te verseker dat vir al die deelnemers dieselfde vrae gevra word, en ’n ervare navorsing toesighouers was deurgaans teenwoordig wat alle data gevalideer het. Kwantitatiewe data is in ’n tabel opgesom ten einde goeie oorsig te bied. Kwalitatiewe data-analise is met die hand gedoen. Die data wat uit die analise na vore gekom het, is geënkodeer en in subtemas en temasgekategoriseer. Die vier temas wat hieruit voortspruit, is faktore betreffende die gesondheidsorgsisteem, kliënte, sosio-ekonomiese en terapie-verwante faktore. Die navorser het n geskrewe verslag saamgestel betreffende die weergawe van die data-analise ten einde te verseker dat belangrike data nie verlore gaan. Die belangrikste bevindinge van die studie dui daarop dat die gemeenskap ’n behoefte aan opleiding het betreffende die onderbreking in TB behandeling, die langdurige tydperk van behandeling, newe-effekte van die medikasie, geneesbaarheid daarvan, hoe die siekte versprei en die gevolge betreffende onvoldoende medikasie ten einde die gemeenskap te bemagtig betreffende die siekte. Die raamwerk van die Nasionale Departement van Gesondheid (2009:45) betreffende die faktore wat bydra tot onderbreking in TB-behandeling is gebruik as konseptuele raamwerk vir die studie. Faye Abdellah se teorie (George, 2002:173-1830)verduidelik verpleging as ’n omvattende diens wat insluit: identifisering van die pasiënt se verplegingsprobleme, die besluit van ’n toepaslike plan van aksie, sowel as die voortgesette sorg betreffende die individu se totale behoeftes.
3

Roles of cellular innate immunity and inflammatory markers in the immune reconstitution syndrome observed during co-infection with tuberculosis in HIV infected patients in Cambodia / Rôles de l'immunité innée cellulaire et marqueurs inflammatoires dans le syndrome de reconstitution immunitaire observé au cours de la co-infection avec la tuberculose chez les patients infectés par le VIH au Cambodge

Nouhin, Janin 19 September 2016 (has links)
Les traitements simultanés des antituberculeux et de thérapie antirétrovirale (ARV) chez les patients co-infectés par le VIH et la tuberculose (TB) peut être compliqué en raison de la survenue du syndrome inflammatoire de reconstitution immunitaire associé à la TB (TB-IRIS) dont le diagnostic est basé sur les manifestations cliniques. La compréhension de l’immunopathologie de TB-IRIS est cruciale pour améliorer le diagnostic et la prise en charge des patients. L'immunité innée semble de plus en plus jouer un rôle dans le TB-IRIS. Dans la présente thèse de doctorat, j'ai étudié le rôle de l'immunité innée cellulaire, notamment des cellules NKT et γδ t, ainsi que l'implication des marqueurs soluble plasmatique : IL-1Ra, sCD14 et sCD163 liés à l’activation des monocytes/macrophages dans la survenue de l’iris chez les patients co-infectés par le VIH et TB au Cambodge.Les résultats ont montré que : 1/. Le TB-IRIS est associé a une forte activation des cellules γδ T et des sous populations γδ2+ avant l’initiation des ARV, 2/. Aucun des marqueurs IL-1Ra, sCD14 et sCD163 n’était prédictif de la survenue de l’iris. L'analyse longitudinale des taux plasmatiques d’ IL-1Ra pourrait être utile pour le diagnostic de l’iris et l’évaluation de la réponse au traitement antituberculeux. En conclusion, nos résultats révèlent l’association entre une activation importante de l’immunité innée et l’émergence de TB-IRIS dans la physiopathologie. De plus, nos données apportent des nouveaux éléments de l'iris et des marqueurs pour évaluer l'efficacité du traitement antituberculeux. / Simultaneous anti-tuberculosis and antiretroviral (ARY) therapy in HIV and tuberculosis (TB) co-infected patients can be complicated due to the occurrence of TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). The diagnosis test of TB-IRIS is not yet available and mainly based on clinical data. A better understanding of TB-IRIS immunopathology is crucial to improve diagnostic test and patients’ clinical outcomes. Innate immunity seems increasingly play a role in TB-IRIS. In the present doctoral thesis, is studied the role of cellular innate immunity, including NKT and γδ t cells, and as well as the implication of IL-1Ra, sCD14 and sCD163 plasma soluble markers related to the activation of monocytes/macrophages in the development of iris in HIV and TB co-infected patients in Cambodia. The results have shown that 1/. TB-IRIS is associated with a strong activation of γδ t cells and γδ2+ subset before initiation of ARY, 2/. None of IL-1Ra, sCD14 and sCD163 markers was predictive of the onset of iris. Longitudinal analysis of IL-1Ra plasma level could be useful for the diagnosis of the iris occurrence and for the evaluation of response to TB-IRIS In conclusion, our results reveal the association between important activation of innate immunity and the emergence of TB-IRIS in the physiopathology. In addition, our data provides new element of TB-IRIS and markers for evaluation of TB treatment efficacy.
4

Patient Characteristics and Treatment Outcomes Among Tuberculosis Patients in Sierra Leone

Sesay, Mohamed Lamin 01 January 2017 (has links)
Despite decades of the implementation of the directly observed therapy short-course (DOTS), Sierra Leone is ranked among the 30 highest TB-burdened countries. Several factors account for unfavorable treatment outcomes, among which are patient characteristics. Previous studies have only focused on treatment compliance without any consideration for the factors that lead to noncompliance to treatment. The purpose of this study was to investigate patient characteristics that are associated with treatment noncompliance (treatment not completed) among TB patients undergoing the DOTS program in Sierra Leone. A retrospective longitudinal quantitative design was used to analyze secondary data from the completed records of 1,633 TB patients, using the Andersen's behavioral model of health services utilization as a theoretical framework work. Descriptive statistics and bivariate and multivariate logistic regressions were used to analyze the data. The results show that there was no significant association between treatment completion and age, gender, and TB-case category. On the other hand, being HIV-positive decreases the odds of treatment completion. Also, the educational level, geographic location, and year of treatment were significantly associated with treatment completion. Overall, program performance improved as the number of dropouts decreased significantly between 2013 and 2015. The social change implication of this study was that it identified HIV-positive patients and rural communities as areas needing specific attention such as the assignment of case managers to ensure compliance thereby improve DOTS program performance, thereby reducing the incidence and transmission of TB
5

Factors affecting treatment outcomes in tuberculosis (TB) patients in the Limpopo Province, South Africa

Gafar, Mohammed Mergni January 2013 (has links)
Thesis (M. Pharm) --University of Limpopo, 2013 / Tuberculosis (TB) threatens the public health all over the world. South Africa is ranked fifth on the list of 22 high burden countries. SA has not achieved the international targets for cure rate and default rate yet. This is attributed to high HIV/AIDS prevalence and emergence of multi- drug resistant TB. Limpopo Province experiences poor TB treatment outcome, in spite of the adoption of strategies that proved globally that they can improve the outcome. The factors affecting treatment outcome in Limpopo Province are as yet undocumented. The specific objectives of this study were to determine the demographic profile of TB patients in the Limpopo Province; to investigate the treatment outcomes and to establish the relationship between age, gender, HIV status, treatment regimen and health facility level and the treatment outcomes in patients diagnosed with pulmonaryTB for period between 2006- 2010, inclusive, in Limpopo Province. Method Retrospective data for the period between 2006 and 2010 (inclusive) were reviewed, and 1200 records of cases of confirmed TB patients were sampled from the ETR.net provincial database. All these patients were diagnosed and treated according to guidelines adopted by the national TB control programme. Standard WHO definitions were used to classify the TB treatment outcome. Chi squire test was used to investigate the association between age, gender, diagnostic category and treatment regimen and treatment outcome. Results Of the 1200 TB cases sampled, 656 (54%) were male. Most of them fell within the age group 22- 55 years (n=871; 72.5%)). According to diagnostic category, 1035 (86.2%) were new cases; 962 (80.1%) cases received regimen I (two months of rifampicin [R], isoniazid [H], pyrazinamide [Z} and ethambutol [E] followed by four months of rifampicin and isoniazid, 2RHZE+ 4RH); 893 (74.4%) cases had successful treatment; 118 (9.8%) defaulted on treatment; 26 (2.2%) had treatment failure, and 163 (13.6%) died. There was a strong association between age (P <0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P< 0.001) and treatment outcome. The success treatment was highly significant (P <0.001) for the cases that fell within the age group 3- 6 years, those that were diagnosed as new cases, those that received treatment at mine health facilities or were treated with regimen III (2RHZ + 4RH). While the default rate was highly significant (P< 0.05) for the cases aged 7- 12 or 22- 55 years, patients that had history of defaulting, and those that received treatment at a community health centre or village health facilities –. treatment failure was highly significant (P< .05) for Those fell within age group 22-55 or 56- 74 years, those had initial treatment failure, those that received treatment at hospital or mobile health facilities or treated with regimen II (3RHZES + 5RH) while the death rate was highly significant (P< 0.05) for the cases either fall within age group 0-2, 22- 55 or 56- 74 years, had initial failure, received treatment at hospital or village health facilities or treated with regimen). The un success rate was very highly significant (P< 0.001) for those either characterized by; fall within age group 22- 55 years, had initial failure, received treatment at hospital or village health facilities or treated with regimen II. Conclusion TB treatment outcome are poor in the Limpopo Province, particularly among patients with previous history of TB treatment, those receiving treatment in hospitals, or those being treated with first line regimen II. This situation requires that the TB control programme and other relevant programmes be strengthened, for instance through integration at facility level, towards more effective response to the challenges which hamper progress towards international targets on TB. Further studies are needed to address the effect of HIV status and AIDS, CD4+ cell counts, anti-retroviral therapy (ART), cotrimoxazole preventive therapy (CPT) and radiological presentation, and their effect on TB treatment outcome in Limpopo Province. Those data are not routinely captured on ETR.net, hence were not included in the present study.
6

Factors affecting treatment outcomes in tuberculosis (TB) patients in the Limpopo Province, South Africa

Gafar, Mohammed Mergni January 2013 (has links)
Thesis (M.Pharm.) --University of Limpopo, 2013 / Tuberculosis (TB) threatens the public health all over the world. South Africa is ranked fifth on the list of 22 high burden countries. SA has not achieved the international targets for cure rate and default rate yet. This is attributed to high HIV/AIDS prevalence and emergence of multi- drug resistant TB. Limpopo Province experiences poor TB treatment outcome, in spite of the adoption of strategies that proved globally that they can improve the outcome. The factors affecting treatment outcome in Limpopo Province are as yet undocumented. The specific objectives of this study were to determine the demographic profile of TB patients in the Limpopo Province; to investigate the treatment outcomes and to establish the relationship between age, gender, HIV status, treatment regimen and health facility level and the treatment outcomes in patients diagnosed with pulmonaryTB for period between 2006- 2010, inclusive, in Limpopo Province. Method Retrospective data for the period between 2006 and 2010 (inclusive) were reviewed, and 1200 records of cases of confirmed TB patients were sampled from the ETR.net provincial database. All these patients were diagnosed and treated according to guidelines adopted by the national TB control programme. Standard WHO definitions were used to classify the TB treatment outcome. Chi squire test was used to investigate the association between age, gender, diagnostic category and treatment regimen and treatment outcome. Results Of the 1200 TB cases sampled, 656 (54%) were male. Most of them fell within the age group 22- 55 years (n=871; 72.5%)). According to diagnostic category, 1035 (86.2%) were new cases; 962 (80.1%) cases received regimen I (two months of rifampicin [R], isoniazid [H], pyrazinamide [Z} and ethambutol [E] followed by four months of rifampicin and isoniazid, 2RHZE+ 4RH); 893 (74.4%) cases had successful treatment; 118 (9.8%) defaulted on treatment; 26 (2.2%) had treatment failure, and 163 (13.6%) died. There was a strong association between age (P <0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P< 0.001) and treatment outcome. The success treatment was highly significant (P <0.001) for the cases that fell within the age group 3- 6 years, those that were diagnosed as new cases, those that received treatment at mine health facilities or were treated with regimen III (2RHZ + 4RH). While the default rate was highly significant (P< 0.05) for the cases aged 7- 12 or 22- 55 years, patients that had history of defaulting, and those that received treatment at a community health centre or village health facilities – treatment failure was highly significant (P< .05) for Those fell within age group 22-55 or 56- 74 years, those had initial treatment failure, those that received treatment at hospital or mobile health facilities or treated with regimen II (3RHZES + 5RH) while the death rate was highly significant (P< 0.05) for the cases either fall within age group 0-2, 22- 55 or 56- 74 years, had initial failure, received treatment at hospital or village health facilities or treated with regimen). The un success rate was very highly significant (P< 0.001) for those either characterized by; fall within age group 22- 55 years, had initial failure, received treatment at hospital or village health facilities or treated with regimen II. Conclusion TB treatment outcome are poor in the Limpopo Province, particularly among patients with previous history of TB treatment, those receiving treatment in hospitals, or those being treated with first line regimen II. This situation requires that the TB control programme and other relevant programmes be strengthened, for instance through integration at facility level, towards more effective response to the challenges which hamper progress towards international targets on TB. Further studies are needed to address the effect of HIV status and AIDS, CD4+ cell counts, anti-retroviral therapy (ART), cotrimoxazole preventive therapy (CPT) and radiological presentation, and their effect on TB treatment outcome in Limpopo Province. Those data are not routinely captured on ETR.net, hence were not included in the present study.
7

Effects of treatment compliance on treatment outcomes for pulmonary tuberculosis patients on Directly Observed Treatment-short Course in Windhoek District, Namibia

Nepolo, Ester Ndahekelekwa January 2016 (has links)
Magister Public Health - MPH / Tuberculosis (TB) is a major health problem worldwide, with an estimated 9 million new cases accounting for an estimated 1.5 million deaths in 2012. Non-compliance with TB treatment has become a major barrier to achieving global TB control targets. Namibia is one of the worst affected countries in Africa with a high case notification rate (CNR) of all forms of TB and relatively low treatment success rate compared to the WHO targets. The study aimed at investigating TB treatment compliance and measuring its association to patient characteristics and treatment outcomes, in determining the effects of compliance on treatment outcomes in Windhoek District. This information is crucial for TB programme management and development of targeted strategies. A quantitative observational analytic study using a retrospective cohort design was adopted. New adult Pulmonary Tuberculosis (PTB) patients treated under DOTS in Windhoek District between 1st January 2013 and 31st December 2013 were included in the study based on specified criteria. Data was collected from the patients TB treatment cards using an extraction tool. Selection and information bias was eliminated by using clearly defined inclusion and exclusion criteria using a pre-tested standardised tool. Statistical analysis using descriptive and analytic statistics was done using Epi Info 7 to determine compliance, treatment outcomes and to measure the associations. Overall treatment compliance (89%), initial phase compliance (97.2%) and continuation phase compliance (88.1%) were reported in the study. Age (OR=4.3 95% CI (1.72 – 9.90), p-value=<0.01) and type of area (OR=0.02 95% CI (1.00 – 1.13), p-value=0.05) were associated with compliance in the continuation phase. Overall, type of area (OR=0.03 95% CI (0.00 – 0.91), p-value=0.04) remains associated with treatment compliance. Treatment success is reported among 86.1% of patients. Poor treatment outcomes are associated with non-compliance in the initial phase ( =49.98, p-value=<0.01), continuation phase ( =98.81, p-value=<0.01) and overall ( =110.02, p-value=<0.01). Overall treatment compliance (89%) although higher than expected was lower than the WHO recommended 90% compliance. Very high compliance (97.2%) were reported in the initial phase of treatment whilst compliance was also lower than desired (88.1%) in the continuation phase. Non-compliance recorded in the continuation phase is in agreement with the literature. Age and type of area are associated with compliance as reported in the continuation phase and overall in this study is new contribution of knowledge. The findings suggest that treatment compliance is associated with treatment success in both phases of treatment and overall. Low compliance especially in the continuation phase could lead to poor treatment outcomes such as prolonged infections, relapse, high TB mortality and drug resistance leading to increased programme costs. The study concludes that non-compliance results in poor treatment outcomes highlighting the need for interventions that address compliance in all phases but specifically within the continuation phase and amongst those at risk of having reduced compliance such as those in rural areas and young adult patients aged (15 – 34 years). Recommendations to the District Management Team and TB Programme Managers include: identification of measures that promote treatment compliance; support and monitoring of TB patients’ compliance continuously; strengthening CB-DOT by increasing CB-DOT points and enhancing CB-DOT supporters’ capacity as well as strengthening record keeping as a monitoring tool to increase compliance and improve treatment outcomes.
8

Health Workers’ Perceptions on Where and How to Integrate Tobacco Use Cessation Services Into Tuberculosis Treatment; A Qualitative Exploratory Study in Uganda

Rutebemberwa, Elizeus, Nyamurungi, Kellen, Joshi, Surabhi, Olando, Yvonne, Mamudu, Hadii M., Pack, Robert P. 01 December 2021 (has links)
Background: Tobacco use is associated with exacerbation of tuberculosis (TB) and poor TB treatment outcomes. Integrating tobacco use cessation within TB treatment could improve healing among TB patients. The aim was to explore perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda. Methods: Between March and April 2019, nine focus group discussions (FGDs) and eight key informant interviews were conducted among health workers attending to patients with tuberculosis on a routine basis in nine facilities from the central, eastern, northern and western parts of Uganda. These facilities were high volume health centres, general hospitals and referral hospitals. The FGD sessions and interviews were tape recorded, transcribed verbatim and analysed using content analysis and the Chronic Care Model as a framework. Results: Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. There was need to coordinate with different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities. Conclusions: Tobacco cessation activities should be provided in a continuum starting in the community before the TB patients get to hospital, during the patients’ interface with hospital treatment and be given in the community after TB patients have been discharged. This requires collaboration between those who carry out health education in communities, the TB treatment supporters and the health workers who treat patients in health facilities.
9

Reduction of diagnostic and treatment delays reduces rifampicin-resistant tuberculosis mortality in Rwanda

Ngabonziza, J.-C.S., Habimana, Y.M., Decroo, T., Migambi, P., Dushime, A., Mazarati, J.B., Rigouts, L., Affolabi, D., Ivan, E., Meehan, Conor J., Van Deun, A., Fissette, K., Habiyambere, I., Nyaruhirira, A.U., Turate, I., Semahore, J.M., Ndjeka, N., Muvunyi, C.M., Condo, J.U., Gasana, M., Hasker, E., Torrea, G., de Jong, B.C. 28 April 2020 (has links)
Yes / SETTING: In 2005, in response to the increasing prevalence of rifampicin-resistant tuberculosis (RR-TB) and poor treatment outcomes, Rwanda initiated the programmatic management of RR-TB, including expanded access to systematic rifampicin drug susceptibility testing (DST) and standardised treatment.OBJECTIVE: To describe trends in diagnostic and treatment delays and estimate their effect on RR-TB mortality.DESIGN: Retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality.RESULTS: Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased from 30.8% in 2006 to 6.9% in 2016. Total delay in starting multidrug-resistant TB (MDR-TB) treatment of more than 100 days was associated with more than two-fold higher odds for dying. When delays were long, empirical RR-TB treatment initiation was associated with a lower mortality.CONCLUSION: The reduction of diagnostic and treatment delays reduced RR-TB mortality. We anticipate that universal testing for RR-TB, short diagnostic and therapeutic delays and effective standardised MDR-TB treatment will further decrease RR-TB mortality in Rwanda.
10

Factors that contribute to treatment defaulting amongst tuberculosis patients in Windhoek district, Namibia

Kakili , Tuwilika January 2010 (has links)
<p>Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The&nbsp / global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa,&nbsp / one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in&nbsp / Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many&nbsp / parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate&nbsp / the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using&nbsp / in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible&nbsp / participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient&rsquo / s experiences of the illness / socio- economic / community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service&nbsp / factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in&nbsp / Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these&nbsp / factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the&nbsp / study are made. </p>

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