Diagnostic yield and grading acid-fast bacilli from serial sputum smears of HIV- infected and uninfected tuberculosis patients in routine microscopy laboratory in Ouagadougou, Burkina Faso

We compared 100 HIV-infected and 100 non-infected adult patients with pulmonary tuberculosis (TB) to evaluate the association between the HIV status and the microscopic yield, and between the HIV status and the grading of acid-fast bacilli (AFB) sputum smears. We stained specimens by Ziehl-Neelsen hot method. The first serial sputum smears diagnosed 89 por cento HIV- infected and 94 por cento uninfected. The additional yields of the second and third sputum smears identified respectively 10 por cento and 1 por cento among the HIV-infected against 5 por cento and 1 por cento among the patients without HIV. Considering grading of AFB, the HIV- positive patients were more scanty and less positive 2+ and 3+ at the first (P=0.089) and the second sputum smears (P=0.010). For the second AFB-smears grading, there was a significant difference between HIV-infected and uninfected among the males (P=0.031), the group of age ranging from 15 to 44 years old (P=0.003) and among the ambulatory patients (P=0.015); when we analyzed data for subgroups by HIV serological status, the difference was not significant in the results among the females (P=0.417) and the TB-hospitalized (P=0.501). In conclusion, the morning sputum smears improved the diagnostic yield in both HIV-infected and uninfected patients. However, globally the frequency of scanty was significantly associated with HIV serological status.

An economic evaluation of the controlled temperature chain approach for vaccine logistics: evidence from a study conducted during a meningitis A vaccine campaign in Togo

Introduction: a recent innovation in support of the final segment of the immunization supply chain is licensing certain vaccines for use in a controlled temperature chain (CTC), which allows excursions into ambient temperatures up to 40°C for a specific number of days immediately prior to administration. However, limited evidence exists on CTC economics to inform investments for labeling other eligible vaccines for CTC use. Using data collected during a MenAfriVac™ campaign in Togo, we estimated economic costs for vaccine logistics when using the CTC approach compared to full cold chain logistics (CCL) approach.Methods: we conducted the study in Togo's Central Region, where two districts were using the CTC approach and two relied on a fullCCL approach during the MenAfriVac™ campaign. Data to estimate vaccine logistics costs were obtained from primary data collected using costing questionnaires and from financial cost data from campaign microplans. Costs are presented in 2014 US dollars.Results: average logistics costs per dose were estimated at $0.026±0.032 for facilities using a CTC and $0.029±0.054 for facilities using the fullCCL approach, but the two estimates were not statistically different. However, if the facilities without refrigerators had not used a CTC but had received daily deliveries of vaccines, the average cost per dose would have increased to $0.063 (range $0.007 to $0.33), with larger logistics cost increases occurring for facilities that were far from the district.Conclusion: using the CTC approach can reduce logistics costs for remote facilities without cold chain infrastructure, which is where CTC is designed to reduce logistical challenges of vaccine distribution