Preventing Tuberculosis Among HIV-Infected Pregnant Women in Lesotho

Tiam, Appolinaire; Machekano, Rhoderick; Gounder, Celine R.; Maama-Maime, Llang Bridget; Ntene-Sealiete, Keletso; Sahu, Maitreyi; Isavwa, Anthony; Oyebanji, Oyebola; Ahimbisibwe, Allan; Mokone, Majoalane; Barnes, Grace L.; Chaisson, Richard E.; Guay, Laura; Kassaye, Seble

doi:10.1097/qai.0000000000000209

Cited by 20 publications

(11 citation statements)

References 23 publications

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“…In addition, enhancing the availability and accessibility of RNTCP facilities in hard-to-reach Adivasi (tribal) areas, where case detection rates are very low, may help to reduce the proportion of India’s population without access to TB care [31]. Finally, various strategies of targeted active case finding—especially higher yield strategies focused on repeated screening of household contacts of known TB patients [79], people living with HIV [80,81], and individuals visiting health care facilities [82]—may also help to substantially reduce Gap 1a/1b by identifying patients who may otherwise not seek TB care or do so with substantial delay [83]. …”

Section: Discussionmentioning

confidence: 99%

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

et al. 2016

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BackgroundIndia has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world’s “missing” patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The “cascade of care” is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions.Methods and FindingsThe care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India’s TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014–2015), one WHO dataset (2015), and three RNTCP reports (2014–2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000–2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB—including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB.The WHO estimated that there were 2,700,000 (95%CI: 1,800,000–3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775–1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival.The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India.ConclusionsIncreasing case detection is critical to improving outcomes in India’s TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition...

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Section: Discussionmentioning

confidence: 99%

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

et al. 2016

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“…A small study of IPT among pregnant women in Lesotho reported a lower proportion of IPT completion (64.5%) [14], probably due the high postpartum dropout that has been well documented among HIV-infected pregnant women [15]. …”

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confidence: 99%

High completion of isoniazid preventive therapy among HIV-infected children and adults in Kinshasa, Democratic Republic of Congo

Yotebieng

Edmonds

Lelo

et al. 2015

Aids

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We assessed isoniazid preventive therapy (IPT) completion and predictors among HIV-infected children and adults in two HIV clinics in Kinshasa, Democratic Republic of Congo. Between September 1, 2012 and June 15, 2013, 546 children (1–15 years) and 1532 adults (> 15 years) were initiated on IPT; 86.6% (408/470) of children and 88.2% (1129/1280) of adults with an IPT outcome completed their therapy. Patients on ART at IPT initiation were more likely to complete IPT.

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“…Among these, research on maternal and child health quality of care, viral load point-of-care devices, and infant point-of-care diagnoses had hardly any publications in the high-priority research category. In addition, research on epidemiology of non-communicable diseases in people living with HIV [41], uptake and effectiveness of isoniazid preventive therapy for opportunistic tuberculosis infection [42], and discordant transmission of HIV in couples [20, 43, 44] had the least number of publications in the same category. Moreover, research on epidemiology of tuberculosis in children [45–48] and impact of HIV on the national health system [20, 49–52] had a low number of publications in the high-priority research category.…”

Section: Resultsmentioning

confidence: 99%

A 30-year bibliometric analysis of research coverage on HIV and AIDS in Lesotho

Mugomeri

Bekele

Mafaesa

et al. 2017

Health Res Policy Sys

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BackgroundGiven the well documented undesired impacts of HIV/AIDS globally, there is a need to create a statistical inventory of research output on HIV/AIDS. This need is particularly important for a country such as Lesotho, whose HIV/AIDS prevalence is one of the highest globally. Research on HIV/AIDS in sub-Saharan Africa continues to trail behind that of other regions, especially those of the developed countries. Lesotho, a sub-Saharan country, is a developing country with lower research output in this area when longitudinally compared to other countries. This study reviewed the volume and scope of the general research output on HIV/AIDS in Lesotho and assessed the coverage of the national research agenda on HIV/AIDS, making recourse to statistical principles.MethodsA bibliometric review of studies on HIV/AIDS retrieved from the SCOPUS and PubMed databases, published within the 30-year period between 1985 and 2016, was conducted. The focus of each of the studies was analysed and the studies were cross-matched with the national research agenda in accordance with bibliometric methodologies.ResultsIn total, 1280 studies comprising 1181 (92.3%) journal articles, 91 (7.1%) books and 8 (0.6%) conference proceedings were retrieved. By proportion, estimation of burden of infection (40.7%) had the highest research volume, while basic (5.5%) and preventive measures (24.4%) and national planning (29.4%) had the lowest. Out of the total studies retrieved, only 516 (40.3%) matched the national research agenda. Research on maternal and child health quality of care, viral load point-of-care devices, and infant point-of-care diagnosis had hardly any publications in the high priority research category of the agenda.ConclusionNotwithstanding a considerable research output on HIV/AIDS for Lesotho, there is insufficient coverage of the national research agenda in this research area. The major research gaps on general research output are in basic and preventive measures as well as national planning. There is also a need to increase targeted funding for HIV/AIDS research to appropriately address the most compelling gaps and national needs.

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Preventing Tuberculosis Among HIV-Infected Pregnant Women in Lesotho

Abstract: Implementation of ACF and IPT is feasible within the MCH setting. Uptake of IPT during pregnancy among HIV-positive women was high, but with a high rate of loss to follow-up.

Cited by 20 publications

References 23 publications

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

High completion of isoniazid preventive therapy among HIV-infected children and adults in Kinshasa, Democratic Republic of Congo

A 30-year bibliometric analysis of research coverage on HIV and AIDS in Lesotho

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