Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Preko P [original query] |
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Leveraging differentiated HIV service delivery to expand tuberculosis preventive treatment: a call to action
Rabkin M , Howard AA , Ehrenkranz P , Fernandez LG , Preko P , Singh V , Tomlinson HL , El-Sadr WM . Int J Tuberc Lung Dis 2020 24 (2) 165-169 Tuberculosis (TB) is the leading cause of death among people living with human immunodeficiency virus (PLHIV), and sub-Saharan Africa has a particularly heavy burden of HIV-associated TB. Although effective TB preventive treatment (TPT) has been available for decades and shorter regimens are newly available in some settings, TPT coverage among PLHIV is suboptimal, leading to preventable illness and death. In 2018, the United Nations High-Level Meeting on Ending Tuberculosis called for ambitious new targets for TPT coverage among PLHIV and many countries in sub-Saharan Africa have redoubled their efforts to take TPT to scale. Importantly, however, this push to expand TPT among PLHIV is taking place in the context of a changing HIV treatment delivery landscape. Countries in sub-Saharan Africa are at the forefront of innovative changes in HIV program design, including a shift towards less-intensive differentiated service delivery (DSD) models for stable patients doing well on antiretroviral therapy. Understanding the opportunities and challenges that DSD presents for TB diagnosis, prevention and linkage to care among PLHIV will be critical to success. |
High uptake of antiretroviral therapy among HIV-positive TB patients receiving co-located services in Swaziland
Pathmanathan I , Pasipamire M , Pals S , Dokubo EK , Preko P , Ao T , Mazibuko S , Ongole J , Dhlamini T , Haumba S . PLoS One 2018 13 (5) e0196831 BACKGROUND: Swaziland has the highest adult HIV prevalence and second highest rate of TB/HIV coinfection globally. Recently, the Ministry of Health and partners have increased integration and co-location of TB/HIV services, but the timing of antiretroviral therapy (ART) relative to TB treatment-a marker of program quality and predictor of outcomes-is unknown. METHODS: We conducted a retrospective analysis of programmatic data from 11 purposefully-sampled facilities to evaluate timely ART provision for HIV-positive TB patients enrolled on TB treatment between July-November 2014. Timely ART was defined as within two weeks of TB treatment initiation for patients with CD4<50/muL or missing, and within eight weeks otherwise. Descriptive statistics were estimated and logistic regression used to assess factors independently associated with timely ART. RESULTS: Of 466 HIV-positive TB patients, 51.5% were male, median age was 35 (interquartile range [IQR]: 29-42), and median CD4 was 137/muL (IQR: 58-268). 189 (40.6%) were on ART prior to, and five (1.8%) did not receive ART within six months of TB treatment initiation. Median time to ART after TB treatment initiation was 15 days (IQR: 14-28). Almost 90% started ART within eight weeks, and 45.5% of those with CD4<50/muL started within two weeks. Using thresholds for "timely ART" according to baseline CD4 count, 73.3% of patients overall received timely ART after TB treatment initiation. Patients with CD4 50-200/muL or >/=200/muL had significantly higher odds of timely ART than patients with CD4<50/muL, with adjusted odds ratios of 11.5 (95% confidence interval [CI]: 5.0-26.6) and 9.6 (95% CI: 4.6-19.9), respectively. TB cure or treatment completion was achieved by 71.1% of patients at six months, but this was not associated with timely ART. CONCLUSIONS: This study demonstrates the relative success of integrated and co-located TB/HIV services in Swaziland, and shows that timely ART uptake for HIV-positive TB patients can be achieved in resource-limited, but integrated settings. Gaps remain in getting patients with CD4<50/muL to receive ART within the recommended two weeks post TB treatment initiation. |
Trends in prevalence of advanced HIV disease at antiretroviral therapy enrollment - 10 countries, 2004-2015
Auld AF , Shiraishi RW , Oboho I , Ross C , Bateganya M , Pelletier V , Dee J , Francois K , Duval N , Antoine M , Delcher C , Desforges G , Griswold M , Domercant JW , Joseph N , Deyde V , Desir Y , Van Onacker JD , Robin E , Chun H , Zulu I , Pathmanathan I , Dokubo EK , Lloyd S , Pati R , Kaplan J , Raizes E , Spira T , Mitruka K , Couto A , Gudo ES , Mbofana F , Briggs M , Alfredo C , Xavier C , Vergara A , Hamunime N , Agolory S , Mutandi G , Shoopala NN , Sawadogo S , Baughman AL , Bashorun A , Dalhatu I , Swaminathan M , Onotu D , Odafe S , Abiri OO , Debem HH , Tomlinson H , Okello V , Preko P , Ao T , Ryan C , Bicego G , Ehrenkranz P , Kamiru H , Nuwagaba-Biribonwoha H , Kwesigabo G , Ramadhani AA , Ng'wangu K , Swai P , Mfaume M , Gongo R , Carpenter D , Mastro TD , Hamilton C , Denison J , Wabwire-Mangen F , Koole O , Torpey K , Williams SG , Colebunders R , Kalamya JN , Namale A , Adler MR , Mugisa B , Gupta S , Tsui S , van Praag E , Nguyen DB , Lyss S , Le Y , Abdul-Quader AS , Do NT , Mulenga M , Hachizovu S , Mugurungi O , Barr BAT , Gonese E , Mutasa-Apollo T , Balachandra S , Behel S , Bingham T , Mackellar D , Lowrance D , Ellerbrock TV . MMWR Morb Mortal Wkly Rep 2017 66 (21) 558-563 Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/muL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,dagger, section sign To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence. |
Delivery of isoniazid preventive therapy to reduce occupational TB among healthcare workers in Swaziland
Calnan M , Haumba S , Matsebula M , Shongwe N , Pasipamire M , Levy NK , Mirira M , Preko P , Smith-Arthur A , Ghazaryan V . S Afr J Infect Dis 2017 32 (1) 39-42 Healthcare workers (HCWs) in Swaziland are at increased risk of acquiring tuberculosis (TB), but existing infection control and occupational health policies often fall short of mitigating the risk of acquiring TB in the workplace. Health service failure to systematically offer isoniazid preventive therapy (IPT) to HCWs, which is endorsed by the World Health Organisation (WHO), contributes signifcantly to the TB incidence among HCWs in high HIV prevalence settings. This paper describes a pilot introduction of IPT to HCWs, and expounds possible determinants for adherence and non-acceptance to IPT. Acceptance to the widespread use of IPT among HCWs can be improved through education on risk and counselling. |
Screening in Maternity to Ascertain Tuberculosis Status (SMATS) study
Broughton E , Haumba S , Calnan M , Ginindsa S , Jeffries R , Maphalala G , Mazibuko S , Mirara M , Modi S , Munyaradzi P , Preko P , Simelane B . BMC Infect Dis 2017 17 (1) 191 BACKGROUND: Diagnosis of tuberculosis is difficult among pregnant women because the signs and symptoms of the disease, such as fatigue, shortness of breath, sweating, cough, and mild fever are similar to some manifestations of pregnancy. It is particularly challenging among HIV-infected women as symptoms are often masked or atypical. Currently, WHO recommends a standard four-symptom screening tool for pregnant and lactating women. There is evidence from South Africa that this screening tool (which, despite complex symptomology in this population, recommends identification of patients with weight loss, fever, current cough and night sweats), may be missing true active TB cases. However there exist several laboratory and clinical procedures that have the potential to improve the sensitivity and specificity of this screening tool. METHODS: This study will evaluate the sensitivity and specificity of the current TB screening tool for pregnant and lactating women, both HIV positive and negative. We will also assess several different enhanced screening algorithm using LAM, IGRA, TST and chest radiography and clinical/laboratory procedures and tests. The study will use a cross-sectional analytical study design involving pregnant and lactating women up to six months post-delivery attending antenatal or postnatal care, respectively in one of three selected public health units in Swaziland. Participants will be consecutively enrolled and will be in one of four groups of interest: HIV infected pregnant women, non-HIV infected pregnant women, HIV infected lactating women and non-HIV infected lactating women. DISCUSSION: We expect in conducting all procedures on all participants regardless of result of the symptom screening we may experience a high refusal rate. However, this risk will be mitigated by the long data collection period of five or more months. |
Enrollment in HIV care two years after HIV diagnosis in the kingdom of Swaziland: An evaluation of a national program of new linkage procedures
MacKellar DA , Williams D , Storer N , Okello V , Azih C , Drummond J , Nuwagaba-Biribonwoha H , Preko P , Morgan RL , Dlamini M , Byrd J , Agolory S , Baughman AL , McNairy ML , Sahabo R , Ehrenkranz P . PLoS One 2016 11 (2) e0150086 To improve early enrollment in HIV care, the Swaziland Ministry of Health implemented new linkage procedures for persons HIV diagnosed during the Soka Uncobe male circumcision campaign (SOKA, 2011-2012) and the Swaziland HIV Incidence Measurement Survey (SHIMS, 2011). Abstraction of clinical records and telephone interviews of a retrospective cohort of HIV-diagnosed SOKA and SHIMS clients were conducted in 2013-2014 to evaluate compliance with new linkage procedures and enrollment in HIV care at 92 facilities throughout Swaziland. Of 1,105 clients evaluated, within 3, 12, and 24 months of diagnosis, an estimated 14.0%, 24.3%, and 37.0% enrolled in HIV care, respectively, after adjusting for lost to follow-up and non-response. Kaplan-Meier functions indicated lower enrollment probability among clients 14-24 (P = 0.0001) and 25-29 (P = 0.001) years of age compared with clients >35 years of age. At 69 facilities to which clients were referred for HIV care, compliance with new linkage procedures was low: referral forms were located for less than half (46.8%) of the clients, and few (9.6%) were recorded in the appointment register or called either before (0.3%) or after (4.9%) their appointment. Of over one thousand clients newly HIV diagnosed in Swaziland in 2011 and 2012, few received linkage services in accordance with national procedures and most had not enrolled in HIV care two years after their diagnosis. Our findings are a call to action to improve linkage services and early enrollment in HIV care in Swaziland. |
Lower levels of antiretroviral therapy enrollment among men with HIV compared with women - 12 countries, 2002-2013
Auld AF , Shiraishi RW , Mbofana F , Couto A , Fetogang EB , El-Halabi S , Lebelonyane R , Pilatwe PT , Hamunime N , Okello V , Mutasa-Apollo T , Mugurungi O , Murungu J , Dzangare J , Kwesigabo G , Wabwire-Mangen F , Mulenga M , Hachizovu S , Ettiegne-Traore V , Mohamed F , Bashorun A , Nhan do T , Hai NH , Quang TH , Van Onacker JD , Francois K , Robin EG , Desforges G , Farahani M , Kamiru H , Nuwagaba-Biribonwoha H , Ehrenkranz P , Denison JA , Koole O , Tsui S , Torpey K , Mukadi YD , van Praag E , Menten J , Mastro TD , Hamilton CD , Abiri OO , Griswold M , Pierre E , Xavier C , Alfredo C , Jobarteh K , Letebele M , Agolory S , Baughman AL , Mutandi G , Preko P , Ryan C , Ao T , Gonese E , Herman-Roloff A , Ekra KA , Kouakou JS , Odafe S , Onotu D , Dalhatu I , Debem HH , Nguyen DB , Yen le N , Abdul-Quader AS , Pelletier V , Williams SG , Behel S , Bicego G , Swaminathan M , Dokubo EK , Adjorlolo-Johnson G , Marlink R , Lowrance D , Spira T , Colebunders R , Bangsberg D , Zee A , Kaplan J , Ellerbrock TV . MMWR Morb Mortal Wkly Rep 2015 64 (46) 1281-6 Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged ≥15 years), 765,087 adult ART patient medical records from 12 countries in five geographic regions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002-2013. This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)(dagger) of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%-83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage. |
Declining tuberculosis notification trend associated with strengthened TB and expanded HIV care in Swaziland
Haumba S , Dlamini T , Calnan M , Ghazaryan V , Smith-Arthur AE , Preko P , Ehrenkranz P . Public Health Action 2015 5 (2) 103-105 This retrospective observational review documents the efforts of the Swaziland National Tuberculosis (TB) Control Programme between 2004 and 2014. The objective is to describe the disparity between actual declines in case notification and increases in estimated incidence. The review of policies and practices shows the most influential factors associated with the decrease in TB case notification to be an increase in access to antiretroviral therapy for co-infected TB patients, the general success of TB and human immunodeficiency virus service integration in the country and improvements in implementation of all components of directly observed treatment, active case finding, and rapid diagnosis using new technologies. |
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