research & publications

CO-MORBIDITIES RESEARCH

Results by County (Approx)
  • 56 results found
  • Integrating Tuberculosis and HIV Services in rural Kenya: uptake and outcomes

    Background:

    An estimated 35.3 million persons worldwide were living with the human immunodeficiency virus (HIV) in 2012, while 8.6 million people developed tuberculosis (TB), the majority of them in sub-Saharan Africa. Kenya is one of the world’s 22 high TB burden2 and high HIV burden countries.


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  • Pilot implementation of a contact tracing intervention for tuberculosis case detection in Kisumu County, Kenya

    Abstract

    Leveraging an existing community health strategy, a contact tracing intervention was piloted under routine programmatic conditions at three facilities in Kisumu County, Kenya. Data collected during a 6-month period were compared to existing programmatic data. After implementation of the intervention, we found enhanced programmatic contact tracing practices, noting an increase in the proportions of index cases traced, symptomatic contacts referred, referred contacts presenting to a facility for tuberculosis screening, and eligible contacts started on isoniazid preventive therapy. As contact tracing is scaled up, health ministries should consider the adoption of similar contact tracing interventions to improve contact tracing practices.


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  • MORTALITY AFTER CLINICAL MANAGEMENT OF AIDS-ASSOCIATED CRYPTOCOCCAL MENINGITIS IN KENYA.

    BACKGROUND:

    Cryptococcal meningitis (CM) is an increasingly prevalent infection among HIV/AIDS patients and is becoming a leading cause of morbidity and mortality in Africa. The short-term prognosis and management of patients with CM may be improved by identifying factors leading to mortality in patients with CM.


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  • Pilot implementation of a contact tracing intervention for tuberculosis case detection in Kisumu County, Kenya

    Leveraging an existing community health strategy, a contact tracing intervention was piloted under routine programmatic conditions at three facilities in Kisumu County, Kenya. Data collected during a 6-month period were compared to existing programmatic data. After implementation of the intervention, we found enhanced programmatic contact tracing practices, noting an increase in the proportions of index cases traced, symptomatic contacts referred, referred contacts presenting to a facility for tuberculosis screening, and eligible contacts started on isoniazid preventive therapy. As contact tracing is scaled up, health ministries should consider the adoption of similar contact tracing interventions to improve contact tracing practices.


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  • Incremental Yield of Including Determine-TB LAM Assay in Diagnostic Algorithms for Hospitalized and Ambulatory HIV-Positive Patients in Kenya.

    BACKGROUND:

    Determine-TB LAM assay is a urine point-of-care test useful for TB diagnosis in HIV-positive patients. We assessed the incremental diagnostic yield of adding LAM to algorithms based on clinical signs, sputum smear-microscopy, chest X-ray and Xpert MTB/RIF in HIV-positive patients with symptoms of pulmonary TB (PTB).


    METHODS:

    Prospective observational cohort of ambulatory (either severely ill or CD4<200cells/μl or with Body Mass Index<17Kg/m2) and hospitalized symptomatic HIV-positive adults in Kenya. Incremental diagnostic yield of adding LAM was the difference in the proportion of confirmed TB patients (positive Xpert or MTB culture) diagnosed by the algorithm with LAM compared to the algorithm without LAM. The multivariable mortality model was adjusted for age, sex, clinical severity, BMI, CD4, ART initiation, LAM result and TB confirmation.


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  • Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya.

    Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN.


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  • Comparative Yield of Different Diagnostic Tests for Tuberculosis among People Living with HIV in Western Kenya.

    BACKGROUND:

    Diagnosis followed by effective treatment of tuberculosis (TB) reduces transmission and saves lives in persons living with HIV (PLHIV). Sputum smear microscopy is widely used for diagnosis, despite limited sensitivity in PLHIV. Evidence is needed to determine the optimal diagnostic approach for these patients.


    METHODS:

    From May 2011 through June 2012, we recruited PLHIV from 15 HIV treatment centers in western Kenya. We collected up to three sputum specimens for Ziehl-Neelsen (ZN) and fluorescence microscopy (FM), GeneXpert MTB/RIF (Xpert), and culture, regardless of symptoms. We calculated the incremental yield of each test, stratifying results by CD4 cell count and specimen type; data were analyzed to account for complex sampling.


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  • Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya.

    BACKGROUND:

    Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya.


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  • Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya.

    OBJECTIVE:

    To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya.


    DESIGN:

    Prospective cohort study.


    METHODS:

    PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and "Improving Diagnosis of TB in HIV-infected persons" (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey.


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  • Using Survival Analysis to Identify Risk Factors for Treatment Interruption among New and Retreatment Tuberculosis Patients in Kenya.

    Despite high tuberculosis (TB) treatment success rate, treatment adherence is one of the major obstacles to tuberculosis control in Kenya. Our objective was to identify patient-related factors that were associated with time to TB treatment interruption and the geographic distribution of the risk of treatment interruption by county.


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  • Treatment outcomes of drug-resistant tuberculosis patients in Kenya.

    Abstract


    SETTING: Successful treatment of drug-resistant tuberculosis (DR-TB) is crucial in preventing disease transmission and reducing related morbidity and mortality. A standardised DR-TB treatment regimen is used in Kenya. Although patients on treatment are monitored, no evaluation of factors affecting treatment outcomes has yet been performed.



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  • Tuberculosis screening outcomes for newly diagnosed persons living with HIV, Nyanza Province, Kenya, 2009.

    To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding.


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  • Impact Of Health Facility And Community Linkages In Tb Contact Tracing

    Background


    WHO and Center for Disease Control and Prevention recommends infection control to reduce the risk of Tuberculosis (TB) transmission. In Kirogo Chest Clinic there was an identified gap of tracing contact of smear positive TB client who were not identified early hence presenting later with active TB. Earlier in 2012 and 2013, health workers requested TB clients to tell their contacts to come to the clinic or bring them along in their next clinic. This was a challenge as most of the contacts never came. To address this, the staff held a multidisciplinary team meeting, discussed the issue and engaged the Community Health Volunteers (CHVs) for identification and tracking at community level. They liaised with the Public Health Officer who linked the chest clinic with CHVs working in the Community Units.



  • Empiric Therapy of Helminth Co-infection to Reduce HIV-1 Disease Progression (THE or PHE)

    Over 25 million HIV-1 infected individuals are currently living in Africa and as many as 50-90% may be co-infected with soil transmitted helminths such as roundworms, hookworms or whipworms. Helminth infection in HIV-1-infected individuals may increase HIV-1 RNA levels and increase the rate of progression of HIV-1 to AIDS. Studies have also shown that successful treatment of helminth co-infection (as documented by clearance of helminth eggs in stool) led to a significant decrease in HIV-1 plasma viral load (-0.36 log10). This change in viral load was significantly greater than that seen in those individuals without documented clearance of their helminth co-infection (+0.67 log10) (p=0.04). Studies conducted in Africa have shown an estimated 2.5-fold increased risk for sexual transmission of the HIV-1 for each log increase in plasma HIV-1 viral load. In addition to direct effects on plasma viral load, the rate of CD4 cell decline in helminth infected individuals may be directly impacted by the significant immune activation seen with such co-infection. The investigators propose a randomized controlled trial examining the potential benefits of routine empiric helminth eradication in HIV-1 infected adults who do not yet qualify for antiretroviral (ARV) therapy in Kenya. The current standard of care of symptomatic diagnosis and treatment will be compared to a systematic empiric scheduled de-worming program for HIV infected adults. The investigators will compare markers of disease progression including rate of CD4 decline and changes in HIV-1 RNA levels between the two treatment arms.


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  • High HIV, HCV And TB Burden Among People Who Use Drugs On Medically Assisted Therapy At Malindi Hospital

    BACKGROUND:

    Globally, people who inject drugs are disproportionately burdened by HIV, tuberculosis and hepatitis. A UNODC study reported 18.3% HIV prevalence among Kenya’s PWID (females 44.5% versus 16% for males) with PWID in Malindi having 21.9% prevalence second highest after Nairobi’s 27.7%. Hepatitis prevalence among PWID significantly higher HCV 22.2%, HBV 24.3%. The high burden of BBIs is attributed to risky injecting and sexual behaviours, compounded by criminalization of drug use, limited health care access, stigmatization and marginalization.


    Objectives:

    Reducing morbidity, mortality and other harms associated with drug-use among people who inject drugs through medically assisted therapy (MAT) at Malindi Sub-County Hospital.


    Methods:

    All eligible persons who injected/used drugs were screened at baseline for urine drug toxicology to confirm opioid use, as well as for HIV, HCV, HBV, pregnancy (female clients), and GeneXpert (if suspected with tuberculosis infection).


    Results:

    By mid-2016, a total 350 clients were enrolled for MAT. Of these, 12% [42] tested HIV positive – females 26.1% (11) versus 73.8 %( 31) males. HCV prevalence was 2.5%, 11.1 % (1) among females versus 88.8% for males. HBV prevalence was 1.7% [6clients], 16.6 % (1) for females versus 83.3% (5) for males. HIV/HCV co-infection was 2.28% overall (8), all males, while 1 male client had HIV/HBV/HCV co-infection. TB prevalence was 4.57%, females 12.5% (2) versus 87.5% (14) for males while TB/HIV coinfection was 6.2%, all males. The burden of non-communicable diseases was low among MAT clients (2 diabetics, 2 hypertensive and 1 thyrotoxicosis). One client with prior history of abdominal surgery developed intestinal obstruction while on methadone. All MAT clients with co-morbidities linked to other services: CCC, Chest Clinic, Sopc, Gopc, Dental clinic and Mopc for comprehensive care. 90% of HIV positive clients received ART and CTX as DOTS while others took at home. Follow up CD4 and Viral Load testing confirmed clinical improvement among MAT clients on treatment. All clients on anti-TB take their dose as DOT at the MAT centre.


    Conclusions, recommendations and implications:

    HIV prevalence among MAT clients more than twice the national HIV prevalence, followed by HCV prevalence. Males have significantly higher HCV burden compared to HIV-burdened females. Daily supervised dispensing of ARVs and anti-TB drugs with methadone improves compliance and treatment outcomes, while reducing risk of drug-resistance and associated mortality. However, high demand for MAT among non-injecting drug users may compromise treatment access for injecting drug users, while stigma and absence of effective hepatitis prevention and treatment interventions compromising quality of care thereby, contributing to sub-optimal adherence. There is urgent need for closing the treatment gap for HIV, TB and hepatitis among PWID in order to reach 90-90-90 targets.



  • OUTCOMES OF RESECTABLE PULMONARY ASPERGILLOMA IN A HIGH TUBERCULOSIS PREVALENCE SETTING BACKGROUND

    BACKGROUND:

    Pulmonary aspergillomata usually develop in patients with underlying structural lung diseases. The mainstay of therapy is considered to be lung resection surgery - both for aspergillomata treatment and prevention of life-threatening haemoptysis


    AIMS AND OBJECTIVES:

    In the present study, we assessed the outcomes of patients with aspergillomata presented to a multi-disciplinary forum for resection and primarily assessed the proportion of patients who had surgery at the end of the follow-up period as well as the time duration to surgery.


    METHODS:

    The medical records of all patients diagnosed as having pulmonary aspergillomata and presented to a multidisciplinary forum for possible surgical resection at the Tygerberg Hospital, between January 2013 and December 2015, were retrospectively reviewed.


    RESULTS:

    Fifty nine patients were included, with a mean (SD) age of 44.5 (± 8.8) years. Thirty six (61.0%) were male, and 13 (22.0%) were infected with human immunodeficiency virus (HIV). A previous history of pulmonary tuberculosis was identified in 83.1% of the patients. One or both upper lobes were involved in 58 of 59 patients (98.3%) and six patients (10.2%) had involvement of more than one lobe. Haemoptysis was the most frequent indication for surgery occurring in 56 patients (94.9%). Eleven patients (18.6%) reported ongoing respiratory symptoms within 90 days following discussion. After discussion, nine patients (15.3%) were considered unfit for surgery. Of those accepted, only 23 (46%) underwent surgical resection, as of 1 June 2016. The median time from presentation to surgery was 190 days (IQR: 134 – 351). Eighteen patients (78.3%) underwent resection of a single lobe, two (8.7%) had double lobectomies and three (13.0%) had pneumonectomies. There was no post-operative mortality. One patient developed bleeding, persistent air leak and aspiration pneumonia post- operatively requiring mechanical ventilation and an extended stay. Three further patients were hospitalised for >7 days, post-operatively. Fungal elements were identified in seventeen specimens (73.9%) of the resected lung. Following surgery, only two patient reported ongoing respiratory symptoms by day 90. Three of the 50 patients (6.0%) died prior to surgery from unknown causes. The reasons for delays and lack of surgery were varied and included: miscommunication (n=3); lack of transport (n=2); hospital bed shortage (n=1); refusal to consent (n=2); loss-to-follow-up (n=12); clinical improvement (n=3); clinical worsening (n=3) and lack of theatre space due to emergency procedures (n=1).


    CONCLUSION:

    Lung resection surgery is considered the mainstay of therapy for pulmonary aspergillomata. However, in our institution, less than half of the patients accepted actually received surgery, waiting times were long (>1yr in 25%) and were associated with mortality. Barriers to prompt surgery are complex, but should be urgently addressed.


  • Prevalence Of Vitamin D Deficiency In Adult Human Immunodeficiency Virus Infected Persons At Mbagathi District Hospital.

    BACKGROUND

    The introduction and increased availability of highly active antiretroviral therapy (HAART) has led to significant reduction in mortality in Human Immunodeficiency Virus (HIV) infected patients. With the increased survival rates HIV infected patients are now at risk of chronic age associated non communicable diseases including bone, metabolic, renal, and cardiovascular conditions. Vitamin D deficiency (VDD) in HIV infected patients has been associated with disease progression and increased mortality. Both HIV and HAART have been shown to increase the risk of vitamin D deficiency. Furthermore, supplementation of vitamin D has been shown to reduce bone mineral density loss related to HAART by up to 50%.


    STUDY OBJECTIVE

    To determine the prevalence of vitamin D deficiency in adult HIV infected persons at Mbagathi district hospital.


    METHODS

    This was a hospital based cross sectional descriptive study conducted between October 2015 and December 2015 involving adult HIV infected persons attending the Comprehensive Care Clinic at Mbagathi district hospital. Medical history was obtained via direct interview and recorded in the study proforma. Blood was then drawn for serum 25 hydroxycholecalciferol (25-VD) and creatinine analysis.


    RESULTS

    A total of 128 HIV infected persons were evaluated, 68% of the patients were females. The population was relatively young with a mean age of 41.4 years. Eight (6.3%) patients were classified as vitamin D deficient (25-VD <20 ng/ml), while thirty eight (29.7%) had vitamin D insufficiency (25-VD 21-29 ng/ml) and eighty two (64%) patients had normal levels (25-VD 30-100 ng/ml). HAART naïve patients were 5.3 times more likely to have vitamin D deficiency. We did not find any associations between vitamin D and age, gender, World Health Organization (WHO) stage, estimated glomerular filtration rate (eGFR) and body mass index (BMI).


    CONCLUSION

    Prevalence of Vitamin D deficiency was found to be low in our study population.


  • Non-Communicable Diseases in HIV infected patients; types, risk factors and services offered in HIV clinics in Kenya

    Background:

    Universal access to ART has resulted in a reduction in HIV related morbidity and mortality. The increase in lifespan has however been accompanied by emergence of several Non-Communicable Diseases (NCDs). NCDs in HIV develop as a consequence of chronic inflammation, immunologic dysfunction, ART side effects, aging, and lifestyle factors. For purposes of this analysis, NCDs include diabetes mellitus (DM), hypertension, obesity, cardiovascular disease, and chronic kidney disease. NCD management is important to sustain gains made in controlling HIV infection and to prevent the double burden of disease in developing countries. This presents a challenge because the patients require close monitoring, have drug-drug interactions, suffer from pill burden and poor adherence. In addition, weaknesses in the health systems e.g. inadequate numbers of healthcare workers and capacity, lack of referral systems, poor access to laboratory tests and imaging, inadequate drugs, as well as lack of data, patient awareness and funding impedes the control NCDs.


    Methodology:

    Systems for screening and management of NCDs in HIV patients were set up . We reviewed patient charts for HIV infected patients with NCD followed up in 25 of these health facilities 3 years after setting up the systems. We analyzed for type of NCD, risk factors, services offered, and adherence using descriptive statistics.


    Results:

    A total of 416 patients with HIV and NCDs were assessed of which 75% had hypertension, 13% had diabetes, 6% were obese, 3% had heart diseases and 2% had chronic kidney disease. The mean age was 48.6 years and males accounted for 24.4% of these patients. Risk factors included smoking (8.6%), alcohol consumption (11.5%), BMI>25 (60.9%) and family history of DM, hypertension or heart disease (34%). Regarding service delivery systems for NCDs in the HIV clinic, 66.0% of the patients had coordinated appointments compared to none at baseline, 55.2% were referred for specialist review, and 74.0% received education related to NCD management compared to none at baseline. The types of messages given during education were promotion of physical activity given to 54.0% of the patients, dietary counseling to 76.1% of the patients and weight loss promotion given to 51.8% of the patients. ART adherence was assessed in 94.1% of the patients out of who 69.6% had good adherence, 4.0% had fair adherence, 2.6% had poor adherence and the remaining patients did not have their adherence level recorded. NCD medication adherence assessment was done in 88.9% of the patients out of who 60.0% had good adherence, 12.7% had fair adherence, 5.8% had poor adherence while the rest did not have their adherence levels recorded. In regard to routine clinical and laboratory monitoring, 93.3% had their BP recorded at every visit, 10.8% had annual lipid profile done, 25.1% had annual creatinine done, 27.2% received random blood sugar test, 5.9% had cardiovascular risk estimation done prior to treatment commencement and only 2.7% had GFR estimation done. Only 1% of the patients received all the monitoring services, 92.7% of the patients received some of the tests and 6.2% received none of these tests.


    Conclusion:

    A lot has been invested in setting up chronic care models for the control of HIV. Lessons learnt here can form a foundation for setting up systems for integrated management of patients with both HIV and NCDs.



  • Cardiovascular health knowledge and preventive practices in people living with HIV in Kenya.

    Background

    Traditional cardiovascular disease (CVD) risk factors contribute to increase risk of CVD in people living with HIV (PLWH). Of all world regions, sub-Saharan Africa has the highest prevalence of HIV yet little is known about PLWH’s CVD knowledge and self- perceived risk for coronary heart disease (CHD). In this study, we assessed PLWH’s knowledge, perception and attitude towards cardiovascular diseases and their prevention.


    Methods

    We conducted a cross-sectional study in the largest HIV care program in western Kenya. Trained research assistants used validated questionnaires to assess CVD risk patterns. We used logistic regression analysis to identify associations between knowledge with demographic variables, HIV disease characteristics, and individuals CVD risk patterns.


    Results

    There were 300 participants in the study; median age (IQR) was 40 (33–46) years and 64% women. The prevalence of dyslipidemia, overweight and obesity were 70%, 33% and 8%, respectively. Participant’s knowledge of risk factors was low with a mean (SD) score of 1.3 (1.3) out of possible 10. Most (77.7%) could not identify any warning signs for heart attack. Higher education was a strong predictor of CVD risk knowledge (6.72, 95% CI 1.98-22.84, P<0.0001). Self-risk perception towards CHD was low (31%) and majority had inappropriate attitude towards CVD risk reduction.


    Conclusion

    Despite a high burden of cardiovascular risk factors, PLWH in Kenya lack CVD knowledge and do not perceived themselves at risk for CHD. These results emphasis the need for behavior changes interventions to address the stigma and promote positive health behaviors among the high risk HIV population in Kenya.



  • Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice

    Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18–29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis.

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  • EndTB (expand new drugs for TB) observational study: treatment of MDR-TB with regimens containing bedaquiline or delamanid.

    To describe patient outcomes and assess factors associated with unfavorable outcomes(treatment failure,lost to follow up and death

  • Factors associated with smear positivity after first line intensive phase treatment among TB patients in Kilifi County.

    To determine factors associated with smear positivity after first line  intensive phase treatment among TB patients

  • Factors associated with quality of sputum specimens and the effectiveness of customized audio visual instructions in sputum production for improved diagnosis of pulmonary tuberculosis

    To determine the factors associated wit the quality of sputum specimens and effectiveness of customized audio visual instructions in sputum production for improved TB diagnosis

  • An Open-Label, Non-Randomized Study of Pharmacokinetic Interactions among Depot Medroxyprogesterone Acetate (DMPA), Rifapentine (RIF) and Efavirenz (EFV) in women co-infected with Human Immunodeficiency Virus (HIV) and Tuberculosis (TB).

    To estimate the optimal dosing frequency of depot MPA (DMPA) for HIV abd TB co-infected women taking EFV- based combination ARV theraphy and RIF containing TB treatment based on a target MPA conc.>0.1mg/ml

  • CMV and HIV status and its impact on Hepatitis B vaccine response.

    To identify factors such as plasma HIV RNA and CD4+ T-cells count that impact HCP B vaccine durability in HIV+ children and adolescents previously vaccinated against Hepatitis B virus.

  • Effectiveness of customized audio visual instructions on mobile phones for production of improved sputum quality in diagnosis of tuberculosis.

    To determine the effectiveness of customized audio visual instructions on mobile phones for production of improved sputum quality ion diagnosis of tuberculosis

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determeine drug quality in relation to antifungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determeine drug quality in relation to antifungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determeine drug quality in relation to antifungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determine drug quality in relation to anti fungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Factors Associated with Default from Treatment among Tuberculosis Patients in Nairobi Province, Kenya

    Tuberculosis is caused mainly by Mycobacterium tuberculosis.' It affects all tissues and organs except hair teeth and nails. Over 2 billion people were estimated to be infected with the tubercle bacilli in 2005. The immune system is able to contain the bacillus. Only 10% of infections progress to clinical disease. Over 90% of global TB cases and deaths occur in the developing countries. The WHO estimates an incidence of 207,311 new cases in Kenya and 44,576 tuberculosis related deaths annually. Kenya is ranked io" among countries with high tuberculosis burden. Tuberculosis treatment requires use of combination of drugs for 6-8 months. Adherence is vital for successful cure and prevention of drug resistance and treatment failure. In the year 2005, 7.6% of patients defaulted from treatment nationally. The high default rate in the country impedes the achievement of the global target to successfully treat 85% of detected TB cases. Treatment adherence is a complex issue and improving treatment outcomes for tuberculosis requires a full understanding of the factors that prevent people from taking medicines correctly and those that help them complete their treatment. Determination of predictive factors for default was thus justified for early interventions and for policy and strategy formulation to address non-compliance of TB treatment. Default from treatment enhances risk of developing multi-drug resistant tuberculosis, lowers treatment success rates and increases cost of treatment. The objective of this study was to determine factors associated with default from tuberculosis treatment in Nairobi. A Case-Control study was used. Defaulters formed the case and the successfully treated the control group. Secondary data from conveniently sampled treatment facilities was used. Further, cases and controls were traced and interviewed using a structured questionnaire. The response variable was default outcome. Independent variables included drug side-effects, knowledge on TB, access to health care, stigmatization, HIV co-infection and demographic and socioeconomic factors among others. Data was analyzed using SPSS and Epi Info statistical software. Descriptive statistics and analyses of contingency tables to determine association were used. Chi-Square, Fishers exact tests and confidence intervals were used to establish significance. Multivariate logistic regression modeling of associated factors and Kaplan-Meier method to determine probability of staying in treatment over time were employed. Results revealed a 16.7% prevalence of treatment default in Nairobi. Default occurred most frequently during the initial three months of treatment. Among defaulters who were AFB smear positive at initiation of treatment, 47.7% defaulted before conversion was confirmed. Major reasons for default included ignorance, traveling, feeling better, side effects, opting for herbal medication, alcohol use, inadequate food, poor facility factors and stigma. Factors independently associated with default included HIV co-infection (OR 1.56, P<O.OOl), the male sex (OR 1.43, P<O.OOl), history of previous default (OR 2.33, P=0.017), herbal medication use (OR 5.7, P=0.017), low income (OR 5.57, P=0.04), inadequate knowledge on TB (OR 8.67, P=0.017) and alcohol use (OR 4.97, P=0.007). Findings from this study indicate that enhanced health education on TB, pre-treatment counseling, advocacy on treatment compliance, social support and integration of TB and HIV services should be prioritized by MOH so as to address tuberculosis treatment default.

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  • Health seeking behavior, practices of TB and access to health care among TB patients in Machakos County, Kenya

    Despite efforts to implementation of the DOTS programme in Kenya since the year (1993) and achieving 100% coverage by the year 1996; new TB cases continue to emerge in communities, a significance of TB transmission. The success of the DOTS programne require total adherence to treatment for those infected with TB and appropriate control measures as stipulated in TB treatment guidelines, trained manpower to manage the infected patients and surveillance. The main objective of this study was to examine the health seeking behavior of TB patients, practices of TB and access to health care. A cross- sectional survey of TB patients was done in Athi- River, Machakos level 5 and Mutituni TB treatment health facilities in Machakos County. A pre-tested self administered questionnaire/ interviews was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance was fixed at 0.05 (p=0.05).The results of this study reveal TB is affecting more males than females (60.4%).Most of the TB patients are young below 40 years accounting for (71.8%), are poor and unemployed (65%).When the TB patient realized they were sick, most of them
    (81.4%) sought informal remedies from private practioners or self medicated. This delayed early opportunity to seek heath care for more than one month by (82%) of the respondents. Failure of the informal treatment and unbearable pains in advanced disease forced the majority (96.8%) to seek health care in designated TB treatment facilities. There is secrecy in TB status disclosure as (75.5%) declined to openly disclose. For those who disclosed (78%) was to a selected family member mainly to seek assistance (90.7%). Across age groups, educational level, marital status, disclosure of TB status was of no statistical significance p=0.462 and openness of status p=0.112 respectively as the majority remained secret. Health education received by (52.8%) in the TB clinics was observed to significantly influence clinic attendance p=0.014 and adherence to treatment p=0.008 as 78.5% attended regularly and 85.5% adhered respectively. Treatment in public facilities is free with the majority (89.9%) reporting attendance. TB patients care in the community is mainly by family members (74.8%), there is no follow up by heath workers and social support group is minimal at (11.4%).The ministry of health needs to address control measures by initiating strict surveillance of TB, initiate community education on best practices of TB and to distigmatize the disease.

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  • The re-emergence of tuberculosis among the economically productive age group in Kenya: the case of Mombasa district

    In this investigation 43 cases of smear positive patients undergoing TB treatment at satellite treatment centres situated within
    Mombasa municipality were observed and interviewed retrospectively. The span of the study was five months commencing
    from April 1997. The study was carried out in collaboration with the National Leprosy and Tuberculosis Programme at Port Reitz,
    Coast General and Ganjoni centres of infectious and contagious diseases in Mombasa district. The data seem to indicate that the
    highest number (97%) of persons affected by TB come from the economically productive age (15-50 years). The possible cause of
    recurrence ofTB in Mombasa district is lifestyle. The majority of the people with sputum smear positive earn below the poverty line.
    They live in rented or overcrowded houses with inadequate ventilation, insufficient sanitary and transport facilities and poor health systems. In addition, there is a general lack of awareness of dangers of infection, spread and prevention ofTB. Areas arranting"closer attention by future research are highlighted in the study.

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  • INVOLVING PRIVATE HEALTH CARE PROVIDERS IN DELIVERY OF TB CARE: GLOBAL STRATEGY

    Traditionally, prevention and control of diseases of public health importance were considered a responsibility of the public health sector. As a consequence, tuberculosis(TB) control services including DOTS programmes in most low-income countries have been planned and designed almost exclusively by National TB Programmes (NTP) and implemented through the available network of public health services. Most countries however have two major sets of health care providers – public, owned by the State and private, comprising a range of institutions and individuals. These include formal and informal as well as fee-for-service or voluntary providers. Over the years, the private health sector has grown considerably in most low-income countries and has outgrown the public health sector in some. For a variety of reasons, all sections of the population including the poor seek care from private practitioners despite
    availability of free or subsidized services in the public health sector. The private sector varies considerably between and within countries in size, composition, distribution, level of organization, types of services delivered and socio-economic groups served.
    Evidence from countries as diverse as India, Kenya, Mexico, Pakistan, Philippines, Republic of Korea, Uganda shows that private practitioners do detect and treat a significant proportion of TB cases (1). Recognising the importance of private health care providers in TB control and realizing the missing emphasis on engaging the private sector among local, national and international TB control planners and programme managers, WHO recently began addressing the issue. This paper presents WHO’s approach to help initiate private provider (PP) involvement in TB care delivery. A global situational assessment, debate and discussion on the findings of the assessment and observations from field-level initiatives in diverse settings have contributed to an evolving global strategy. The
    strategy takes into account barriers to and enablers of collaboration. While the strategy remains global, the aim is to help address the issue that is, in many ways, local, better, speedier and sustainable TB control remain the ultimate goal.

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  • High Prevalence of Pulmonary Tuberculosis and Inadequate Case Finding in Rural Western Kenya

    Case finding and treatment of symptomatic patients with infectious tuberculosis (TB) are the core elements of the global TB
    control strategy of the World Health Organization (WHO) (1). Estimates suggest low case finding in Africa (2), but data are
    limited (3, 4). The HIV epidemic and, more recently, improved case finding have contributed to substantial increases in the
    notification rates in Africa over the past 2 decades (5, 6). The complex interactions between HIV and TB, including the difficulty
    of diagnosing TB in HIV-infected patients, have increased the difficulties in assessing case detection (6).
    Case finding in countries with high TB burdens depends primarily on detecting TB among symptomatic patients who
    present to health services. This policy was based on results of active case-finding studies in India and Kenya in the 1970s and
    1980s (7–12), which found that most people with prevalent TB had sought care previously for their respiratory symptoms,
    suggesting that improved case detection in health facilities would effectively identify people with TB. Modeling studies suggest that the goals for TB control are unlikely to be met without continued improvements in case detection to beyond the current global target of 70% (13) and that substantial improvement in TB control can be expected from improved case finding, including in populations with high HIV prevalence (14, 15). Only a few recent studies have investigated the prevalence of pulmonary TB (PTB) in Africa to evaluate case detection of PTB, in particular in populations with high HIV prevalence (16–21). We conducted a cross-sectional study in a rural population of approximately 134,000 people in Nyanza Province in western Kenya (the Asembo area of Rarieda District and the Gem District) to determine: (1) the prevalence of bacteriologically confirmed PTB; (2) among PTB cases identified, their HIV prevalence; and (3) their contact with health providers

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  • INNOVATIONS IN TB DATA QUALITY:

    Monitoring and evaluation (M&E) are critical to measuring and reporting on the success of National TB (Tuberculosis) Programs (NTPs) and the TB CARE I/II projects. While governments and donors are placing greater emphasis on results, at the country level,
    greater attention is being paid to the use of data for improving patient care and enhancing program management. In order to ensure that adequate capacity exists to meet the increasingly stringent M&E requirements, this course was designed to build the capacity of M&E Officers of NTPs and technical partners.

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  • Reducing Early Mortality & Morbidity by Empiric Tuberculosis (TB) Treatment

    People with HIV have a high chance of becoming infected with TB, especially when they live in areas where TB infection is common. It can be difficult to diagnose TB in people who need to start HIV treatment right away. Within about 6 months after starting HIV treatment, some of these people can become very sick with TB and can even die from it.
    This study is being done in people who are starting HIV treatment and who live in areas where the TB infection rate is high. The purpose of this study is to test an experimental approach to TB treatment to see if it is better than the usual approach. The experimental approach is to start TB treatment at the same time as HIV treatment, even when TB infection has not been found. The usual approach is to start TB treatment only if TB infection is found.
    In this study, half of the people will start TB treatment at the same time as they start their HIV treatment. The other half will start TB treatment only if TB infection is found.
    The study will also test how safe and effective it is to start TB treatment at about the same time as HIV treatment even when TB infection has not been found. The study will collect information about diet, whether (and when) people in the study become sicker or die, how well their HIV is controlled, how they are feeling, how they are taking their medications, whether it matters where they live or what kind of HIV and TB care is standard, how many people are diagnosed with TB while in the study, and how the cost of the two treatment options on a national level could be compared.

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  • Immediate Versus Deferred Start of Anti-HIV Therapy in HIV-Infected Adults Being Treated for Tuberculosis

    REMoxTB is a study for the "Rapid Evaluation of Moxifloxacin in the treatment of sputum smear positive tuberculosis". REMoxTB aims to find and evaluate new drugs and regimens that shorten the duration of tuberculosis therapy.
    The purpose of REMoxTB is to evaluate the efficacy, safety and acceptability of two Moxifloxacin-containing treatment combinations to determine whether substituting Ethambutol with Moxifloxacin in one combination, and/or substituting Isoniazid with Moxifloxacin in another combination, makes it possible to reduce the duration of treatment for TB

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  • Use of National Tunerculosis Programme Data to Improve The Quality of TB Services In KNH

    Kenyatta National HospitalLinett K. MakonRespirating & Infectious Disease Unit, KNH
  • Knowledge, Attitudes And Practices On Tuberculosis (TB) Management Among Private Health Care Providers In Kawangware, Nairobi, Kenya

    Dagoretti North, NairobiDr. Barbara W. Mambo UNITID, University of Nairobi
  • Evaluation Of TB/HIV Services For Children In Kenya

    Coast, Nyanza, Eastern, Western anf NairobiDr. J. Sitienei Division of Communicable Disease Prevention and Control
  • Evaluation of Loop-Mediated Isothermal Amplification As A Point-Of-Care Diagnostic Tool For Mycobacterium Tuberculosis

    TB Central Reference LaboratorySylvia Wambui Thiong’o Dept. of Medical Microbiology, University of Nairobi
  • Barriers To Accessing Antiretroviral Therapy Among Tb Patients Newly Diagnosed With Hiv In Selected Health Facilities, Nairobi County

    Nairobi CountyDr. Irene Njahira MukuiSchool of Public Health, University of Nairobi
  • To Determine The Prevalence Of Multidrug Resistant Tuberculosis (MDRTB) Prevalence Among Previously Treated Cases In Nairobi, Kenya

    Nairobi CountyJohn Kibet Kirui Dept. of Microbiology Kenyatta University
  • A retrospective study on the management of multi-drug resistant tuberculosis in Kenyatta National Hospital for the period January 2013-December 2013

    Kenyatta National HospitalMichael Ngigi School of Pharmacy, University of Nairobi
  • Diagnosis Of Active Pulmonary Tuberculosis Usng The Xpert Htb/Rif Assay In Smear Negative Tuberculosis Suspects At Kenyatta National Hospital And Mbagathi District Hospital

    KNH and Mbagathi District HospitalDr. Nkengasong Ajua Alemanji Dept. of Clinical Medicine & Therapeutics, University of Nairobi
  • Determinants of Tuberculosis Treatment Outcomes of Sputum Positive Patients In Kamukunji District Nairobi County

    Nairobi CountySophia Medina AliGrate Lakes University Kisumu
  • T-Helper 17 Cells Responses Among TB/HIV Coinfected Subjects In Nairobi, Kenya

    Nairobi CountyRodah Kamakia Seleyian Centre for Biotechnology and Bioinformatics, University f Nairobi