Global evidence directing regional preventive strategies in Southeast Asia for fighting TB/HIV

Mn, Aung; Moolphate, Saiyud; Paudel, Damodar; M, Jayathunge Ph; Duangrithi, Duangjai; Wangdi, Kinley; Tn, Aung; Lorga, Thaworn; Higuchi, Kazue

doi:10.3855/jidc.2903

Cited by 12 publications

(13 citation statements)

References 44 publications

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“…ART coverage in Thailand will be only 54% once the new ART guideline is adopted [9]. The integration of ART services to routine primary healthcare may be a practical way to sustain the expansion of ART coverage [7,23,29]. Task shifting, the focus of the current study, may represent such an initiative.…”

Section: Discussionmentioning

confidence: 99%

“…ART is evidence-based life-saving treatment for PLHIV [7,11]. ART delivery methods are to be compared in a patient-centered approach, accounting for different contexts of the countries [12].…”

Section: Introductionmentioning

confidence: 99%

“…Thailand is the most highly HIV-prevalent country in Southeast Asia [6,7]. All citizens have free ART access within the Thai health system [3].…”

Section: Introductionmentioning

confidence: 99%

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Satisfaction of HIV patients with task-shifted primary care service versus routine hospital service in northern Thailand

Aung

Moolphate

Kitajima

et al. 2015

J Infect Dev Ctries

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Introduction: Shifting the task of HIV care to primary care providers is an important strategy to sustain expanding access to antiretroviral therapy (ART) in high HIV burden countries like Thailand. In a pilot project, the task of following up ART-receiving patients was shifted from a physician-led HIV clinic team based at district level community hospital, to a nurse-led primary healthcare team of seven primary care centers, based at sub-district level in a district of Chiang Mai in northern Thailand. This study aimed to evaluate the task-shifted ART service in a patient-centered approach. Methodology: Patients' satisfaction level was assessed cross-sectionally in a sample of 198 patients, which included 66 people living with HIV (PLHIV) receiving task-shifted ART service and matched controls in a ratio of 1:2. HIV immunological outcome was compared in a retrospective cohort of a year follow-up. Transculturally translated patient satisfaction questionnaire short form (PSQ-18) was used. Multivariate analysis of variance compared seven domains of patients' satisfaction levels. Results: Community hospital patients expressed significantly higher levels of satisfaction with the technical quality, communication, and time spent by the service provider, whereas the task-shifted model patients experienced significantly better accessibility and convenience of the service. At the one-year follow up, CD4 counts of the two groups were not significantly different. Conclusion: Future research and training programs should aim to improve the technical quality and communication skills of nurse-led ART service teams to shift the task of HIV care and sustain expansion of ART access in primary care settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Satisfaction of HIV patients with task-shifted primary care service versus routine hospital service in northern Thailand

Aung

Moolphate

Kitajima

et al. 2015

J Infect Dev Ctries

Self Cite

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“…Scores were ranked based on Zeman DH principle and the total ranking scores were used to assess overall performance [18,19] [15][16][17][18][19][20]. Cost estimates were generated through consideration of all substantial resource inputs necessary to perform each diagnostic test, including laboratory overhead costs, personnel costs, laboratory equipment, consumable supplies, test reagents, sample collection, transportation, and sample decontamination.…”

Section: Test Performancementioning

confidence: 99%

“…Furthermore, culture and GeneXpert algorithms have been found to be more cost effective in reducing mortality than the current practice (symptoms screening, sputum smear, and chest radiography) [15,16].…”

Section: Introductionmentioning

confidence: 99%

A suggested algorithm for detection of multi drug-resistant tuberculosis in Zimbabwe

Makamure

Makumbirofa

Bandason

et al. 2017

J Infect Dev Ctries

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Introduction: Rapid genotypic and phenotypic methods for multi-drug-resistant-tuberculosis (MDR-TB) detection are now widely available. Zimbabwe adopted the use of GeneXpert-MTB/RIF, microscopic-observation-drug-susceptibility-assay (MODS) and Mycobacteria-GrowthIndicator-Tube (MGIT) drug-susceptibility-testing (DST). Data is limited on the ideal combination of use of these methods in resource limited settings. Methodology: Between August 2014 to July 2015, 211 sputa from MDR-TB suspects were tested with GeneXpert-MTB/RIF, MODS, manual-MGIT and Lowenstein-Jensen (LJ)-DST to determine diagnostic accuracy and turnaround-time (TAT), with LJ-DST as the gold standard. A performance score ranking table for diagnostic accuracy, TAT, costs, facilities and expertise requirements, was used to determine the most favourable tool. Results: GeneXpert-MTB/RIF sensitivity was 96% (95%CI:80-100) and specificity was 95% (95%CI:90-97). MODS sensitivity was 88% (95%CI:68-97) and specificity was 97% (95%CI:87-100). Manual MGIT-DST had slightly lower sensitivity of 80% (95%CI:59-93). Median time to detection of MDR-TB was <1 day (IQR:0-0) for Xpert, 14 days (IQR:11-31) for MODS, 21 days (IQR:7-22) for MGIT-DST and 28 days (IQR:25-28) for LJ-DST. Operational costs for MODS, MGIT-DST, and GeneXpert-MTB/RIF were $21.20, $27.52 and $39.76 respectively. From a summation of scores including facility and expertise requirements per diagnostic technique, GeneXpert-MTB/RIF was the most favourable tool, followed by MODS and MGIT-DST. Conclusions: For best scale-up of MDR-TB diagnosis in Zimbabwe, GeneXpert-MTB/RIF can be used for rapid detection of TB in smear negative cases, RIF-susceptibility for early treatment initiation and probable MDR-TB. MODS can rapidly confirm probable MDR-TB detected by GeneXpert-MTB/RIF, manual-MGIT can provide early results for susceptibility to other antibiotics, with affordable costs, with LJ-DST confirming discordant DSTs.

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Evidence to inform resource allocation for tuberculosis control in Myanmar: a systematic review based on the SYSRA framework

Khan

Khilji

Saw

et al. 2016

Health Policy Plan.

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Myanmar represents an extreme example of the difficulties in optimally allocating resources for maximum public health benefit, on the basis of limited information. At the recent Myanmar Health Forum 'Investing in Health' much of the discussion revolved around what to invest in, how health systems could be strengthened, and what research and capacity building areas the international donor community should prioritise for support. Funding for infectious disease control, particularly HIV and tuberculosis, is being channelled to the country at an unprecedented rate, but very little research has been conducted in recent years, and existing information has not yet been synthesised. This paper presents findings of the first systematic literature review on tuberculosis control and the health system in Myanmar, with the aim of informing the development of optimal research priorities and strategies. Medline and grey literature were searched for relevant papers. Inclusion criteria and analyses were structured to capture data on the Myanmar health system, healthcare delivery, financing, tuberculosis control indicators and information systems. A total of 77 papers were included in the analysis. The results indicate that there has been a large increase in the number of peer-reviewed articles published on tuberculosis in Myanmar over the past decade, although the absolute number of studies remains small. We identified several areas in which evidence to inform policy and resource allocation decisions is lacking, including research focused on rural and/or vulnerable populations, analyses of risk factors for TB and drug resistance that can inform prevention strategies and economic analyses for optimising resource allocation. The gaps in research to inform policy identified through this study may be relevant to other low resource settings with extremely limited research capacity.

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Global evidence directing regional preventive strategies in Southeast Asia for fighting TB/HIV

Cited by 12 publications

References 44 publications

Satisfaction of HIV patients with task-shifted primary care service versus routine hospital service in northern Thailand

Satisfaction of HIV patients with task-shifted primary care service versus routine hospital service in northern Thailand

A suggested algorithm for detection of multi drug-resistant tuberculosis in Zimbabwe

Evidence to inform resource allocation for tuberculosis control in Myanmar: a systematic review based on the SYSRA framework

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