An assessment on the implementation of same day antiretroviral therapy initiation in eThekwini clinics, KwaZulu­Natal, South Africa

The World Health Organization (WHO) recom mends same day initiation (SDI) of antiretroviral therapy (ART) for all individuals diagnosed with HIV irrespective of CD4+ count or clinical stage. Implementation of program is still far from reaching its goals. This study assessed the level of implementation of same day ART initiation. A longitudinal study was conducted at four primary healthcare clinics in eThekwini municipality KwaZulu Natal. Data was collected between June 2020 to October 2020 using a data extraction form. Data on individuals tested HIV positive, number of SDI of ART; and clinicians working on UTT program were compiled from clinic registers, and Three Interlinked Electronic Registers.Net (TIER.Net). Non governmental organisations (NGO) supporting the facility and services information was collected. Among the 403 individuals who tested HIV positive, 279 (69.2%) were initiated on ART on the same day of HIV diagnosis from the four facilities. There was a significant association between health facility and number of HIV positive individuals initiated on SDI (chi square=10.59; P value=0.008). There was a significant association between facilities with support from all NGOs and ART SDI (chi square=10.18; P value=0.015. There was a significant association between staff provision in a facility and SDI (chi square=7.51; P value=0.006). Urban areas clinics were more likely to have high uptake of SDI compared to rural clinics (chi square=11,29; P value=0.003). Implementation of the Universal Test and Treat program varies by facility indi cating the need for the government to monitor and standardize implementation of the policy if the program is to yield success.

Drug-resistance of MDR-TB in Xi’an between 2018 and 2020 and the impact of COVID-19 epidemic prevention and control on it / 西安交通大学学报(医学版)

【Objective】 To understand the epidemic status of drug-resistant Mycobacteriun tuberculosis in Xi’an in the past three years, and the impact of COVID-19 epidemic during 2020 so as to provide basic information for local multidrug-resistant tuberculosis (MDR-TB) prevention and treatment. 【Methods】 Tuberculosis (TB) detected by sputum culture, the corresponding drug susceptibility tests data, and basic clinical information of TB patients diagnosed in Xi’an from January 2018 to October 2020 were collected from the management system; then the epidemic status and the drug resistance status were analyzed. Multinomial logistic regression was used to analyze the relationship between the patients’ treatment history and the drug resistance of TB strains, and the trend of changes in the drug resistance rate in retreated patients. 【Results】 In the past three years, there was a total drug resistance rate of 25.3% in 5 146 strains of MTB, and 24.8% in treatment initiation and 38.22% in retreatment, respectively. The treatment initiation patients showed a decreased MDR-TB detection rate, and the retreated patients had an increased MDR-TB detection rate. The spectrum of MDR-TB in the retreated patients gradually became more complicated, and the resistance rate of second-line drugs such as Kanamycin and Ofloxacin gradually increased. There were 10 drug-resistant combinations mainly in H+R+S and H+R+S+E. During the year 2020 of COVID-19 epidemic, the number of initial and retreated patients decreased significantly compared with that in 2018 and 2019, but with no difference in the drug-resistance rate. There was an increasing detection rate of PDR and MDR-TB strains in the retreated patients. Multinomial logistic regression results showed that in 2020 the retreated patients had 4.28 times of developing PDR-TB (P=0.001, 95% CI=1.417-12.930), and 5.378 times of developing MDR-TB (P<0.001, 95% CI=2.641-10.952) than patients of treatment initiation. 【Conclusion】 In the past three years, the prevention and control of drug-resistant TB in Xi’an has achieved some progress, but drug resistance in retreated patients is still serious. To avoid and reduce the development of drug-resistant TB, precise and active intervention measures should be taken, and health management of TB patients should be strengthened, especially during the current period of COVID-19 epidemic prevention and control.

Socio-demographic Factors Associated with Treatment Initiation Delays among Tuberculosis Patients in Namibia

Background: Delayed tuberculosis (TB) treatment increases the rate of spread of the bacilli in the community and mortality rates. Rapid diagnosis and early TB treatment initiation are crucial to successful outcomes and delays affect TB control programs. In Namibia, there is a paucity of data on the demographic factors affecting TB treatment initiation since GeneXpert MTB/RIF (Xpert) assay was introduced in 2017. Methods:This was a descriptive cross-sectional retrospective study conducted at Katutura Hospital TB clinic from 1stJuly 2018 to 31stMarch 2019. A total of seventy-two (72) participants comprising twenty-five (25) rifampicin resistant-TB (RR-TB) and forty-seven(47) non-RR-TB adult patients were enrolled using consecutive sampling. Patients’ medical records, Xpert results and a questionnaire were used to collect data. The data were analyzed using Stata statistical software version 12. Association between socio-demographic factors and treatment initiation delays were established using logistic regression analysis.Results:Staying with a TB patient (AOR=17.22, 95% CI: 2.29-129.773), employment status (AOR=1.23, 95% CI, 002-129), previous TB treatment (AOR=2.19, 95% CI: 0.076-0.86) and being HIV positive (AOR= 1.23, 95% CI: 0.0034-057) were thesocio-demographic factorsthat weresignificantly associated with treatment initiation delays.Treatment initiation delay median time at Katutura Intermediate Hospital TB Clinic was 10 days (IQR: 1-32) and 3 days (IQR: 0-12) for RR-TB and non-RR-TB respectively.Conclusion: The prolonged treatment initiation delays among HIV positive RR-TB patients might be due to low adherence to HIV care interventions. Staying with a household TB patient and those who were previously treated for TB were also associated with treatment initiation delays. Poor health systems infrastructure and stigma could be the determinants of this delay in these groups. An integrated family-based approach to TB and HIV care involving health care workers can mitigate TB treatment delays post-diagnosis. Further studies should explore the factors associated with late initiation to second-line treatment from a community perspective. Lastly, there is a need to assess the cost-utility of bedaquiline and delamanid drugs roll-out in Namibian health care in comparisonwith the standard treatment.