Free to read. Twelve months after tools were introduced, clinic records were abstracted to assess changes in couples HIV testing, LTC, and relinkage.
Staff interviews assessed the feasibility and acceptability of the service delivery model. HIV prevalence was high among TB patients during the study period Compared to pre-implementation, couples HIV testing increased in both clusters from 1. Documented LTC increased from 5. Additional increases in LTC from Staff perceived little burden associated with service delivery. This study demonstrated a feasible, low-burden approach to expand couples HIV testing and linkage of HIV-positive persons to care.
TB settings in sub-Saharan Africa serve populations at disproportionate risk for HIV infection and should be considered key venues to expand access to effective HIV prevention strategies for both patients and their partners. Counseling partners together as part of a couples HIV testing and counseling CHTC strategy increases knowledge about transmission risks and benefits of prevention Kilembe et al.
HIV prevalence in Tanzania is 5. The intervention was implemented in 12 TB clinics in Pwani, Tanzania. The clinics were selected by convenience within two geographical clusters Cluster 1 comprised four clinics and Cluster 2 comprised eight clinics with similar catchment populations. Each cluster included at least one referral hospital district or regional level , a health center, and several directly observed therapy DOT centers. In a modified stepped-wedge design, the HIV prevention training for providers and peer volunteers was staggered across the two clusters, following the introduction of a set of enhanced record-keeping tools see Table 1.
Schematic of orientations for new documentation tools and staff training phases across two TB clinic clusters in Pwani, Tanzania. In January , study staff visited all 12 clinics to provide copies of the documentation tools.
In parallel with the provider training, a 5-day training was provided to peer volunteers to strengthen their existing supportive activities.
At the end of June, the training was repeated for Cluster 2 clinic staff and volunteers. All staff who provided patient care at one of the clinics, e.
Patient-level data were retrospectively abstracted in February from the unit TB register, the unit HTS register, and the referral logbook. No personally identifying information was abstracted and no patient data were collected beyond that which the facility routinely collected to document service delivery.
Study teams conducted monthly site visits to provide supportive supervision on data quality. The mixed-methods survey was conducted on-site by Swahili-speaking interviewers from December to February The survey took approximately 30 minutes to complete. There was no reimbursement for participation. We categorized data into time points corresponding with key intervention activities see Table 1. Using unit HTS register data, we examined HIV prevalence among HTS clients, serostatus of partner pairs, and change over time in the proportion of clients with a documented couples counseling service.
Descriptive statistics and qualitative responses from provider surveys were summarized. Among HTS clients, Of clients diagnosed HIV-positive, TB patients were more likely to have an HIV diagnosis Among HTS clients, partner groupings were identified were couples and three were groupings of three partners. The majority of partner groupings The proportion of HTS clients who tested as a partner grouping increased significantly for Cluster 1: Time 1 was significantly different from Time 2 and 3 Table 3.
The proportion of HTS clients who received couples counseling also increased from Time 0 1. Introducing the enhanced documentation was associated with increased recording of linkages from Time 0 5.
Most providers Providers indicated that they asked patients about sex partners and counseled partners about HIV testing. Challenges to testing partners and linking them to care included partner refusal, reporting that their partner already had a screening at another facility, or were not ready to be tested. Other challenges included the time it takes to do the counseling, the stigma that patients may feel in association with being counseled as a couple, or concern about confidentiality, and the stigma associated with the diagnosis itself.
While our intervention demonstrated significant increases in these services, improvement did not consistently align with the introduction of the training across the clinic clusters.
Readiness of Healthcare facilities with Tuberculosis services to manage Diabetes mellitus in Tanzania: a nationwide analysis for evidence-informed policy-making in high burden settings. Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact.
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Attachment: Submitted filename: Comments. Abstract Introduction Double disease burden such as Tuberculosis and Diabetes mellitus comorbidity is evident and on rising especially in high burden settings such as Tanzania. Results Out of healthcare facilities with tuberculosis services included in the current study, Conclusion Although the majority of the healthcare facilities with tuberculosis services had diabetes mellitus services the overall readiness was low.
Introduction Despite the decline of the mortality rate of active Tuberculosis TB since , TB remains one of the top ten cause of mortality worldwide [ 1 ]. Material and methods Study design and data source The current study was based on the secondary data analysis of the cross-sectional survey of the — Tanzania Service Provision Assessment TSPA. Open in a separate window. Fig 1. Selection of health facilities included in the current analysis.
Operational definition of terms Service availability In this study, it is defined as the "percentage of healthcare facilities with tuberculosis services offering diabetes mellitus services": diagnosis and treatment. Readiness In this study, it is defined as "the capacity of the healthcare facilities with tuberculosis services to provide management for diabetes mellitus". Clinic In this study, it refers to a non-publicly owned health facility that provides outpatient curative services [ 27 ].
Dispensary Is regarded as the lowest level health facility that provides only outpatient curative services just like clinics [ 27 ]. Health centres Constitutes the first referral health facility that provides a wide range of services including basic curative and operative services [ 27 ].
Measure of variables Outcome variables The first outcome variable was the "availability" of diabetes services in tuberculosis health facilities.
Results Baseline characteristics of tuberculosis health facilities A total of health facilities reported to provide management for tuberculosis were assessed. Availability of diabetes services A total of facilities reported to provide tuberculosis management were assessed for the availability of diabetes services. Fig 2. Fig 3. Error bar represents standard error. The readiness of tuberculosis facilities to provide diabetes management The overall readiness of tuberculosis facilities to provide diabetes management was low, Fig 4.
Domain-specific readiness index None of the tuberculosis facilities was ready to provide management for tuberculosis in terms of trained staff and guidelines domain. Discussion Integrated management of tuberculosis-diabetes in health facilities dedicated to providing services for either of the two diseases condition is of paramount importance in a setting with a high burden of tuberculosis and diabetes such as Tanzania. Conclusions Although the majority of the tuberculosis healthcare facilities reported to provide management for diabetes mellitus the overall readiness was low.
Funding Statement The author s received no specific funding for this work. References 1. Global tuberculosis report Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. Addressing the double-burden of diabetes and tuberculosis: lessons from Kyrgyzstan.
Global Health. Globalization and Health ; ; 13 : Tuberculosis Prevalence in Tanzania. Accessed on 21 October Global Report on Diabetes. Isbn ; ISBN 92 4 7. Diabetes in Sub Saharan Africa — Epidemiology and public health implications.
A systematic review. BMC Public Health. The global burden of disease Update ; Strategic and action plan for the Prevention and control of non communicable diseases in Tanzania — Tanzania Steps Surveys Report. Implementing the End TB strategy. The essentials. Diabetes and pulmonary tuberculosis: a global overview with special focus on the situation in Asian countries with high TB-DM burden.
Glob Health Action. Association between diabetes mellitus and multi-drug-resistant tuberculosis: a protocol for a systematic review and meta-analysis. Syst Rev. Williams B, editor. PLoS Med. Mutual impact of diabetes mellitus and tuberculosis in China. Biomed Environ Sci. Siddiqui A. Role of Diabetes in prevalence of Tuberculosis.
J Diabetes Metab. Association between pulmonary tuberculosis and Type 2 diabetes in Sudanese patients. Int J Mycobacteriology. Transient hyperglycemia in patients with tuberculosis in Tanzania: Implications for diabetes screening algorithms. J Infect Dis. The role of diabetes co-morbidity for tuberculosis treatment outcomes: a prospective cohort study from Mwanza, Tanzania.
BMC Infect Dis. Association between tuberculosis, diabetes and 25 hydroxyvitamin D in Tanzania: A longitudinal case control study. BMC Infectious Diseases; ; 16 : 1—9.
Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania ADEPT for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study. BMJ Open. Availability and readiness of diabetes health facilities to manage tuberculosis in Tanzania: A path towards integrating tuberculosis-diabetes services in a high burden setting?
Bintabara D, Shayo FK. Prim Care Diabetes. Primary Care Diabetes Europe; ; 15 : — Geneva: WHO. Glob Heal Sci Pract. Saudi J Dent Res. The Saudi Journal for Dental Research; ; 7 : — Kenya Working Papers No. Shayo FK, Bintabara D. DST of culture samples might also be incomplete. To our knowledge, no recent studies have been performed in sub-Saharan Africa to quantify the above-mentioned gaps.
We thus conducted a study to determine 1 if the number of annually notified retreatment cases corresponded to the number of sputum sam-ples received by the reference laboratories, and 2 the number of samples that were culture-positive and had DST results.
The study was conducted between June and November in Tanzania, an African country with a population of about 46 million, with a high TB and human immunodeficiency virus burden. The study included 1 all TB patients who were notified as retreatment cases between and , and 2 culture and DST results at the reference and three zonal laboratories.
This was a cross-sectional analysis of routine programme data. Retreatment TB cases receive a retreatment drug regimen according to national and World Health Organization guidelines. Each patient diagnosed as being a retreatment case is required to submit one sputum sample for culture at one of the three zonal reference laboratories located in different regions of the country or at the Central Tuberculosis Reference Laboratory CTRL located in Dar es Salaam.
The primary responsibility for sending sputum specimens of retreatment cases lies with the health facilities that diagnose the retreatment cases. Sputum samples and isolates are transported through the normal postal service. Data were obtained from nine annual NTLP reports and 21 laboratory registers from the zonal and reference laboratories covering this 9-year period. Data were double-entered by two independent encoders, and validated using EpiData entry software, version 3.
Discordances were resolved by cross-checking with the paper registers. Data were exported to SPSS version The Figure shows the shortfall in sputum samples received in comparison with notified retreatment cases for the period — Number of annually notified retreatment cases and annual number of sputum samples received by reference laboratories for culture and drug susceptibility testing in Tanzania, — The Table shows the comparison of the notified retreatment cases and the progressive losses in numbers at the various stages from sputum reception at the laboratory to mycobacterial culture and eventual DST.
Annually notified retreatment cases and sputum samples received and processed by zonal and reference laboratories for culture and DST in Tanzania, — This study shows that less than one in every 20 notified retreatment TB cases underwent DST, primarily due to failure to receive sputum samples at the reference and zonal laboratories.
There is thus a major gap between existing policy guidelines and the performance of the NTLP. The strengths of this study are that we conducted our audit over a 9-year period, data were sourced from programme registers and nationally endorsed reports, and as the analysis included countrywide data it is likely to be representative on a national level.
Other limitations include the inability to validate the previously collected routine data and the possibility that reference laboratories discarded sputum samples that consisted only of saliva or with long transfer times without being recorded.
The findings from this study raise a number of issues that merit discussion. We do not know the reasons for this, but possibilities include poor guideline implementation by clinicians, weaknesses in the sputum transportation system, 10 shortcomings in recording and limited laboratory capacity.
Second, immediate measures should be put in place to correct this situation, including the introduction of quarterly monitoring and reporting of gaps in sputum samples received from retreatment cases, and regular supervisory visits to check the accuracy of the data. An audit of the sputum transport chain is also needed to identify areas that would benefit from direct support. Third, the evidence from this audit shows that the performance of the laboratories is good, especially in recent years; the main problem thus appears to lie in getting sputum specimens from the peripheral health facilities to the laboratories.
The primary purpose of sending sputum samples systematically from retreatment cases to the laboratory is to detect drug-resistant TB and administer appropriate treatment regimens. Failure of the laboratory to receive sputum specimens implies that those with drug-resistant TB will not be diagnosed and they therefore risk receiving sub-optimal treatment. This in turn could lead to the development and transmission of MDR-TB, which is a major public health concern. A final point is whether the laboratories could cope with the increased workload associated with all retreatment patients submitting their sputum specimens for culture and DST.
From an operational perspective, this might require first prioritising culture and DST for high-risk groups such as those who fail treatment. The way forward is to strengthen the overall laboratory capacity and foster decentralisation, with the use of rapid DST methods.
This study reveals a considerable gap between notified retreatment cases and sputum samples received for culture and DST, and immediate steps should be taken to address this problem. Read article at publisher's site DOI : Pan Afr Med J , , 02 Jun PLoS One , 14 4 :e, 08 Apr Cited by: 1 article PMID: FRes , 7, 05 Jul To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Public Health Action , 8 2 , 01 Jun Overall, one of the most important goals of the teams is to help build linkages between public health and academia, explains Adams, who provided a summary of the latest Fogarty grant and planned training activities at the symposium. The result will be a win-win for everyone, helping to affect change and to inform program direction and public health activities.
Tuberculosis is now the leading infectious disease cause of death in the world and roughly one-third of TB patients in Tanzania have underlying HIV infection, according to Adams.
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