Linkage to care and treatment outcomes for patients diagnosed with drug-susceptible tuberculosis using Xpert MTB/RIF assay in Thaba-Tseka district in Lesotho

Mabote, Nteseng; Mamo, Meseret; Nsakala, Bienvenu Lengo; Lanje, Samson; Mwanawabene, Ntumwa R.; Katende, Bulemba

doi:10.1016/j.ijregi.2022.08.010

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Additionally, the results from our study suggest that this diagnostic model had little impact on pediatric and adolescent COVID-19, TB and HIV case finding in participants who were between the age of 5 and 18 years. On the other hand, the overall TB and HIV linkage to care rates within four weeks of diagnosis were higher than reported in similar experiences (45)(46)(47)(48), however when comparing to global targets, this model fell short in ART initiation rates (75% vs 95%), and met the TB treatment initiation target (90% vs. 90%) (49,50). As the COVID-19 pandemic surged, and lockdowns led to the cancellation of essential health services, global health actors advocated to adapt services that integrated TB, HIV and COVID-19 activities in sub-Saharan Africa (29,(42)(43)(44).…”

Section: Comparison Performance Of Tb and Hiv Services With Similar H...contrasting

confidence: 52%

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Katende¹,

Bresser

Kamele³

et al. 2022

Preprint

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Introduction The surge of the COVID-19 pandemic challenged health services globally, and in Lesotho, the HIV and tuberculosis (TB) services were similarly affected. Integrated, multi-disease diagnostic services were proposed solutions to mitigate these disruptions. We describe and evaluate the effect of an integrated, hospital-based COVID-19, TB and HIV screening and diagnostic model in two rural districts in Lesotho, during the period between December 2020 and August 2022. Methods Adults and children above 5 years attending two hospitals were screened for COVID-19 and TB symptoms. After a positive screening, participants were offered to enroll in a service model that included clinical evaluation, chest radiography, SARS-CoV-2, Xpert MTB/RIF Ultra and HIV testing. Participants diagnosed with COVID-19, TB, or HIV were contacted after 28 days evaluate their health status, and linkage to HIV or TB services. Results Of the 179160 participants screened, 6623(37%) screened positive, and 4371(66%) were enrolled in this service model, yielding a total of 458 diagnoses. One positive rapid antigen test for SARS-CoV-2 was found per 11 participants screened, one Xpert-positive TB case was diagnosed per 85 people screened, and 1 new HIV diagnosis was done per 182 people screened. Of the 321(82.9%) participants contacted after 28 days of diagnosis, 304(94.7%) reported to be healthy. Of the individuals that were newly diagnosed with HIV or TB, 18/24(75.0%) and 46/51(90.1%) started treatment. This service showed no difference in the detection of new HIV and TB cases when compared to other hospitals, where no such integrated service model was provided. Conclusion This screening and diagnostic model successfully maintained same-day, integrated COVID-19, TB, and HIV testing services through different COVID-19 incidence periods in a resource-limited context. There were positive effects in avoiding diagnostic delays and ensuring linkage to services, however, efficiencies were contingent on the successful adaptation to the changing environment.

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Section: Comparison Performance Of Tb and Hiv Services With Similar H...contrasting

confidence: 52%

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Katende¹,

Bresser

Kamele³

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Additionally, the results from our study suggest that this diagnostic model had little impact on pediatric and adolescent COVID-19, TB, and HIV case finding in participants who were between the age of 5 and 18 years, although the numbers are small. On the other hand, the overall TB and HIV linkage to care rates within four weeks of diagnosis were higher than reported in similar experiences [47][48][49][50], however when comparing to global targets, this model fell short in ART initiation rates (75% vs 95%), and met the TB treatment initiation target (90% vs. 90%) [51,52].…”

Section: Discussionmentioning

confidence: 85%

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Katende¹,

Bresser

Kamele³

et al. 2023

PLOS Glob Public Health

Self Cite

View full text Add to dashboard Cite

The surge of the COVID-19 pandemic challenged health services globally, and in Lesotho, the HIV and tuberculosis (TB) services were similarly affected. Integrated, multi-disease diagnostic services were proposed solutions to mitigate these disruptions. We describe and evaluate the effect of an integrated, hospital-based COVID-19, TB and HIV screening and diagnostic model in two rural districts in Lesotho, during the period between December 2020 and August 2022. Adults, hospital staff, and children above 5 years attending two hospitals were pre-screened for COVID-19 and TB symptoms. After a positive pre-screening, participants were offered to enroll in a service model that included clinical evaluation, chest radiography, SARS-CoV-2, TB, and HIV testing. Participants diagnosed with COVID-19, TB, or HIV were contacted after 28 days to evaluate their health status and linkage to HIV and/or TB care services. Of the 179160 participants pre-screened, 6623(3.7%) pre-screened positive, and 4371(66%) were enrolled in this service model. Of the total 458 diagnoses, only 17 happened in children. One positive rapid antigen test for SARS-CoV-2 was found per 11 participants enrolled, one Xpert-positive TB case was diagnosed per 85 people enrolled, and 1 new HIV diagnosis was done per 182 people enrolled. Of the 321(82.9%) participants contacted after 28 days of diagnosis, 304(94.7%) reported to be healthy. Of the individuals that were newly diagnosed with HIV or TB, 18/24(75.0%) and 46/51(90.1%) started treatment within 28 days of the diagnosis. This screening and diagnostic model successfully maintained same-day, integrated COVID-19, TB, and HIV testing services, despite frequent disruptions caused by the surge of COVID-19 waves, healthcare seeking patterns, and the volatile context (social measures, travel restrictions, population lockdowns). There were positive effects in avoiding diagnostic delays and ensuring linkage to services, however, diagnostic yields for adults and children were low. To inform future preparedness plans, research will need to identify essential health interventions and how to optimize them along each phase of the emergency response.

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“…Health system challenges and centralised services may also contribute to delayed linkage to care and treatment initiation. Based on Lesotho’s national drug-resistant TB guidelines, all bacteriologically confirmed drug-resistant TB patients should be referred to a specialised hospital for treatment initiation [ 30 , 31 ]. Centralised approaches may lead to delays along the care cascade, resulting in morbidity, mortality, and ongoing TB transmission [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

Oyewusi,

Zeng,

Seung

et al. 2024

Global Health Action

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Background A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear. Objectives We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection. Methods Secondary data from a prospective cohort of patients initiating a longer (18–20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status. Results Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status. Conclusions Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.

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Linkage to care and treatment outcomes for patients diagnosed with drug-susceptible tuberculosis using Xpert MTB/RIF assay in Thaba-Tseka district in Lesotho

Cited by 3 publications

References 14 publications

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Impact of a multi-disease integrated screening and diagnostic model for COVID-19, TB, and HIV in Lesotho

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

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