ABSTRACT
Background: People living with HIV (PLHIV) bear 20 times higher risk of acquiring tuberculosis (TB) compared to people without HIV. The World Health Organization recommends TB preventive treatment (TPT) for PLHIV to reduce this risk. However, according to the 2020 Global TB Report, only half of PLHIV were started on TPT globally in 2019, with the lowest coverage observed in low-income countries including Tanzania, where TPT provision is part of the standard of care for eligible PLHIV in Tanzania. We describe programmatic efforts to scale up TPT in 11 regions accounting for half of the 1.5 million PLHIV on ART in Tanzania. Method(s): Starting in 2018, PEPFAR, through the U.S. Centers for Disease Control and Prevention (CDC), supported the Government of Tanzania to accelerate TPT provision by: (1) training and mentoring healthcare workers, (2) integrating isoniazid into supply chain plans at the regional level, and (3) convening quarterly meetings at national and regional levels for program and supply chain monitoring and coordination. Additionally, CDC launched focused regional support interventions, with TPT among its priorities, aiming to facilitate real-time data-driven site monitoring, increased accountability, and on-the-ground coordination with local health authorities and implementing partners. We analyzed routine programmatic data reported in PEPFAR's data reporting system for fiscal years (FY) FY2018 through FY2021. Result(s): The number of PLHIV of all ages who initiated TPT increased from 67,510 in FY2018 to 268,909 in FY2019. Despite coinciding with the COVID-19 pandemic, the initiation numbers in FY2020 were sustained at 264,465 and dropped by about one-third in FY2021 (182,823) compared to the previous year. TPT completion rates among those initiated also showed a positive trend;38% in FY2018, 85% in FY2019, 90% in FY2020, and 91% in FY2021. Conclusion(s): Our findings demonstrate substantial acceleration of TPT initiation and a significant increase in TPT completion rates over the four-year period in 11 regions in Tanzania. The policy of once-in-a-lifetime TPT for PLHIV means fewer people are eligible for TPT over time, which might account for lower numbers of PLHIV initiated on TPT in FY2021. Completion remained high among those who initiated TPT. The strategic shift focusing on capacity building, supply chain strengthening, and site-level monitoring may have contributed to the improvements in TPT initiation and completion.
ABSTRACT
Background:The coronavirus disease 2019 (COVID-19) is a highly infectious respiratory disease. There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone, and supportive care and protection of vital organ function are performed for the patients. This study summarized the clinical characteristics, drug treatments, and risk factors for the severity and prognosis of COVID-19 in Sierra Leone to provide evidence for the treatment of COVID-19.Methods:Data of 180 adult COVID-19 patients from the 34th Military Hospital in Freetown Sierra Leone between March 31, 2020 and August 11, 2020 were retrospectively collected. Patients with severe and critically ill are classified in the severe group, while patients that presented asymptomatic, mild, and moderate disease were grouped in the non-severe group. The clinical and laboratory information was retrospectively collected to assess the risk factors and treatment strategies for severe COVID-19. Demographic information, travel history, clinical symptoms and signs, laboratory detection results, chest examination findings, therapeutics, and clinical outcomes were collected from each case file. Multivariate logistic analysis was adopted to identify the risk factors for deaths. Additionally, the clinical efficacy of dexamethasone treatment was investigated.Results:Seventy-six (42.22%) cases were confirmed with severe COVID-19, while 104 patients (57.78%) were divided into the non-severe group. Fever (56.67%, 102/180) and cough (50.00%, 90/180) were the common symptoms of COVID-19. The death rate was 18.89% (34/180), and severe pneumonia (44.12%, 15/34) and septic shock (23.53%, 8/34) represented the leading reasons for deaths. The older age population, a combination of hypertension and diabetes, the presence of pneumonia, and high levels of inflammatory markers were significantly associated with severity of COVID-19 development (P < 0.05 for all). Altered level of consciousness [odds ratio (OR) = 56.574, 95% confidence interval (CI) 5.645-566.940, P = 0.001], high levels of neutrophils (OR = 1.341, 95%CI 1.109-1.621, P = 0.002) and C-reactive protein (CRP) (OR = 1.014, 95%CI 1.003-1.025, P = 0.016) might be indicators for COVID-19 deaths. Dexamethasone treatment could reduce mortality [30.36% (17/56) vs. 50.00% (10/20)] among severe COVID-19 cases, but the results were not statistically significant (P > 0.05).Conclusions:The development and prognosis of COVID-19 may be significantly correlated with consciousness status, and the levels of neutrophils and CRP. © 2022 Journal of Bone and Joint Surgery Inc.. All rights reserved.
ABSTRACT
Background: Long COVID is increasingly recognized as a post-viral syndrome;however general knowledge within the medical field is limited and many with the syndrome continue to face challenges accessing healthcare. The present study examined long COVID patients' perceptions and experiences of medical care. Methods: Participants (N=123) with protracted COVID A-136 symptoms (? 3 months) were recruited via social media and completed online measures of premorbid health, COVID-19 positivity, symptoms, recovery, and perceptions of their healthcare experience. Satisfaction with medical care was rated on a scale of 0 ?very dissatisfied? to 4 ?very satisfied.? Results: Participant satisfaction of long COVID related healthcare ranged from ?dissatisfaction? with their emergency room experience (M=1.45, SD=1.37) to ?neither satisfied nor dissatisfied? for cardiology (M=2.43, SD=1.25). Fifty-six participants (46%) received an anxiety disorder diagnosis by at least one physician despite experiencing symptoms that were not consistent with the diagnosis (e.g. protracted fever, anosmia). As a result, they felt dismissed (84%), unheard (64%), angry (54%), and delayed (29%) or discontinued medical care (25%). Common themes in the open-ended responses included perceiving providers to be dismissive of long COVID medical literature (18%), female patients' belief that clinician response and treatment would have been different if they were male (15%), and a desire for clinicians to recognize limits of their knowledge (11%). Ten percent reported positive experiences, specifically when the relationship felt collaborative and/or the clinician recognized a need to learn more about post-COVID syndromes and complications. Another 5% acknowledged and empathized with challenges faced by the medical community during the pandemic. Discussion: These findings suggest that long COVID patients are generally dissatisfied with their healthcare experiences, and that, in line with research in other populations, engaging the patient's experience, working collaboratively, and recognizing limits of knowledge contribute to a more positive experience. When a formal mental health evaluation supports a psychiatric diagnosis, clinicians can improve patient engagement and treatment compliance by acknowledging symptoms that are inconsistent with such diagnosis and referring to other specialists as appropriate.