Perception, acceptability and challenges of digital adherence technology among TB healthcare workers.

INTRODUCTION: Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital adherence technologies (DATs) offer a promising approach to non-adherence to medication and improving treatment outcomes. This study explores the perception, acceptability, and challenges of DATs among healthcare workers (HCWs). METHODS: The study was conducted in eight states in Nigeria among Health Care workers involved in treating patients with TB. This was a descriptive cross-sectional study using an open questionnaire and analysed using IBM SPSS v25. RESULTS: Twenty-three HCWs (95.8%) agreed that DATs helped them provide better support and counselling to their patients. All of them would recommend DATs to their patients and found it easy to explain them. Eleven (45.8%) of them were not able to use DATs on a few occasions; their reasons were poor network (n = 9, 37.5%) and (n = 1, 4.2%) power failure. CONCLUSION: DATs help HCWs provide better support and care regarding real-time tracking of their patients' adherence to treatment and possibly reduction of attrition. This implies that DATs are a suitable alternative to DOT to help HCWs provide the best care and support to their patients towards achieving the End TB targets.

INTRODUCTION: Le traitement réussi de la TB nécessite des niveaux élevés d'observance du traitement. Cela s'est avéré inférieur à l'optimal avec le traitement sous observation directe, et les technologies d'observance numérique (DAT) offrent une approche prometteuse de la non-observance des médicaments et de l'amélioration des résultats du traitement. Cette étude explore la perception, l'acceptabilité et les défis des DAT chez les travailleurs de la santé (HCW, pour l'anglais « healthcare worker ¼). MÉTHODES: L'étude a été menée dans huit États du Nigeria auprès de travailleurs de la santé impliqués dans le traitement des patients atteints de TB. Il s'agissait d'une étude transversale descriptive utilisant un questionnaire ouvert et analysée à l'aide d'IBM SPSS v25. RÉSULTATS: Vingt-trois HCW (95,8%) ont convenu que les DAT les aidaient à fournir un meilleur soutien et des conseils à leurs patients. Tous recommandaient les fichiers DAT à leurs patients et trouvaient facile de les expliquer. Onze d'entre eux (45,8%) n'ont pas pu utiliser les fichiers DAT à quelques reprises, en raison d'une mauvaise qualité du réseau (n = 9 ; 37,5%) et d'une panne de courant (n = 1 ; 4,2%). CONCLUSION: Les DAT aident les HCW à fournir un meilleur soutien et des soins en ce qui concerne le suivi en temps réel de l'observance du traitement par leurs patients et éventuellement la réduction de l'attrition. Cela implique que les DAT sont une alternative appropriée au DOT pour aider les travailleurs de la santé à fournir les meilleurs soins et le meilleur soutien à leurs patients pour atteindre les objectifs de l'éradication de la TB.

Appraising perception, accessibility and uptake of DAT among patients with TB.

INTRODUCTION: Poor adherence to TB treatment poses a significant public health threat to TB control programmes. The sustainability of directly observed treatment has been questioned because of its non-patient-centred approach and resource-intensive nature, and Digital Adherence Technologies (DATs) provide a suitable alternative. This study assessed the feasibility and acceptability of DATs among patients with TB. METHODS: This descriptive study was conducted in eight states in Nigeria among all patients with drug-susceptible TB. RESULT: A total of 230 patients (89.1%) own a phone that no one else uses, and 18 (7.0%) use a family phone. A higher proportion of 189 (73.3%) have airtime credit and 119 (46.1%) have internet credit on their phone. In addition, 216 (83.7%) stated that the reminders they received on their phone helped them remember to take their medicine. Only 11 (4.3%) patients missed a dose of the TB medicine. Equally, 11 (4.3%) patients had taken their TB medicine without using DAT. Of these, 7 (63.3%) did not use DATs because they forgot to text medication labels, and 3 (27.6%) did so because of poor network. Only four (1.6%) purchased additional items to support the use of DATs. CONCLUSION: DATs are acceptable in a wide variety of settings, even with reported challenges. Implementation efforts should ensure access, address technical challenges, and minimise additional cost to patients.

INTRODUCTION: La mauvaise observance du traitement antituberculeux constitue une menace importante pour la santé publique pour les programmes de lutte contre la TB. La durabilité du traitement sous observation directe a été remise en question en raison de son approche non centrée sur le patient et de sa nature gourmande en ressources, et les technologies d'observance numérique (DAT) constituent une alternative appropriée. Cette étude a évalué la faisabilité et l'acceptabilité des DAT chez les patients atteints de TB. MÉTHODES: Cette étude descriptive a été menée dans huit États du Nigeria auprès de tous les patients atteints de TB pharmacosensible. RÉSULTAT: Un total de 230 patients (89,1%) possèdent un téléphone que personne d'autre n'utilise, et 18 (7,0%) utilisent un téléphone familial. Une proportion plus élevée de 189 (73,3%) ont du crédit de temps d'antenne et 119 (46,1%) ont du crédit Internet sur leur téléphone. De plus, 216 (83,7%) ont déclaré que les rappels qu'ils ont reçus sur leur téléphone les ont aidés à se rappeler de prendre leurs médicaments. Seuls 11 patients (4,3%) ont manqué une dose du médicament antituberculeux. De même, 11 patients (4,3%) avaient pris leur médicament antituberculeux sans utiliser de DAT. De ce nombre, 7 (63,3%) n'ont pas utilisé de fichiers DAT parce qu'ils ont oublié d'envoyer des étiquettes de médicaments par texto, et 3 (27,6%) l'ont fait en raison d'un réseau médiocre. Seulement quatre (1,6%) ont acheté des articles supplémentaires pour soutenir l'utilisation des fichiers DAT. CONCLUSION: Les fichiers DAT sont acceptables dans une grande variété de contextes, même en cas de problèmes signalés. Les efforts de mise en œuvre doivent garantir l'accès, relever les défis techniques et minimiser les coûts supplémentaires pour les patients.

Assessment of TB underreporting by level of reporting system in Lagos, Nigeria.

BACKGROUND: Nigeria has an estimated TB prevalence of 219 per 100,000 population. In 2019, Nigeria diagnosed and notified 27% of the WHO-estimated cases of all forms of TB and contributed 11% of the missing TB cases globally. OBJECTIVE: To assess TB underreporting by type and level of health facility (HF), and associated factors in Lagos State, Nigeria. METHODOLOGY: Quantitative secondary data analysis of TB cases was conducted in 2015. χ2 test was used to assess the association between treatment initiation, TB underreporting, local government area (LGA) and HF characteristics. RESULTS: Overall, 2,064 persons with bacteriologically confirmed TB (15.5%) were not matched to patients in sampled TB registers. Treatment status was unknown for 86 cases (IQR 55-97) per LGA. LGAs with higher case-loads had higher proportions of cases with unknown TB status. Discrepant reporting of treated TB was also common (60% HFs). Primary-level TB treatment facilities and unengaged private facilities were less likely to notify. CONCLUSION: There was TB under-reporting across all types and levels of HFs and LGAs. There is a need to revise or strengthen the process of supervision and data quality assurance system at all levels.

CONTEXTE: Le Nigeria a une prévalence de la TB estimée à 219 pour 100 000 habitants. En 2019, le Nigéria a diagnostiqué et notifié 27% des cas estimés par l'OMS de toutes les formes de TB et a contribué à 11% des cas de TB manquants dans le monde. OBJECTIF: Évaluer la sous-déclaration de la TB par type et niveau d'établissement de santé (HF), et les facteurs associés dans l'État de Lagos, au Nigeria. MÉTHODES: Une analyse quantitative des données secondaires des cas de TB a été réalisée en 2015. Le test χ2 a été utilisé pour évaluer l'association entre l'initiation du traitement, la sous-déclaration de la TB, la zone de gouvernement local (LGA) et les caractéristiques des HF. RÉSULTATS: Dans l'ensemble, 2 064 personnes ayant une TB confirmée par épreuve bactériologique (15,5%) n'ont pas été appariées à des patients dans les registres de TB échantillonnés. Le statut de traitement était inconnu pour 86 cas (IQR 55­97) par LGA. Les LGA ayant un plus grand nombre de cas avaient une plus grande proportion de cas dont le statut de traitement était inconnu. La déclaration discrète de la TB traitée était également fréquente (60% des HF). Les établissements de traitement de la TB de premier niveau et les établissements privés non engagés étaient moins susceptibles de faire des déclarations. CONCLUSION: Il y avait une sous-déclaration de la TB dans tous les types et niveaux d'HF et de LGA. Il est nécessaire de réviser ou de renforcer le processus de supervision et le système d'assurance qualité des données à tous les niveaux.

Introducing bedaquiline: experiences from the Challenge TB Project.

BACKGROUND: Drug-resistant tuberculosis (DR-TB) remains a global public health crisis. In 2013, the World Health Organization recommended the introduction of bedaquiline (BDQ) for eligible DR-TB patients.METHODS: We conducted a retrospective review and analyses of project reports from 2016 to mid-2019 on the processes, activities implemented, available results on enrolment and interim treatment outcomes, across the 23 Challenge TB (CTB) supported countries.RESULTS: Initial introduction of BDQ-containing regimens in the 23 CTB-supported countries took on average 2 years, with subsequent nation-wide scale-up achieved in Ethiopia and Kyrgyzstan within a short time period. Successful implementation required critical interventions including advocacy, revision of policies and guidelines, capacity building of health care workers, and strengthening of laboratory networks. The number of countries providing BDQ increased from 9 to 23; 9398 patients were enrolled on bedaquiline containing regimens; 71% were culture-negative after 6 months of treatment; and the number of countries reporting serious adverse events increased (from 5 to 18). Major challenges included limited in-country coordination with drug regulatory agencies, unrealistic quantification and drug ordering, weak laboratory networks and reporting systems for drug safety.CONCLUSION: BDQ introduction required a systematic and programmatic approach. The initial time investment helped achieve initial introduction and scale-up of coverage, ownership and sustainability by National TB Programmes.

Unsuccessful Xpert® MTB/RIF results: the Nigerian experience.

Setting: Nigeria, a high tuberculosis (TB) burden country. Objective: To study the rate, distribution and causes of unsuccessful Xpert® MTB/RIF test outcomes, with the aim of identifying key areas that need to be strengthened for optimal performance of the assay. Design: This was a retrospective analysis of data uploaded between January and December 2015 from Xpert facilities to the central server using GXAlert. Result: Of 52 219 test results uploaded from 176 Xpert machines, 22.5% were positive for Mycobacterium tuberculosis, 10.8% of which were rifampicin-resistant; 4.7% of the total number of results were invalid, 4.2% had error results and 2.1% no result outcomes. Technical errors were most frequent (69%); these were non-seasonal and occurred in all geopolitical regions and at all health facility levels. Temperature-related errors were more prevalent in the North-West Region, with peaks in April to June. Peak periods for temperature and machine malfunction errors coincided with the periods of low utilisation of the assay. Conclusion: The key challenge affecting performance was poor adherence to standard operating procedures. Periodic refresher training courses, regular supervision, preventive maintenance of Xpert machines and proper storage of cartridges are strategies that could improve Xpert performance.

Contexte : Le Nigeria, pays lourdement frappé par la tuberculose.Objectif : Etudier le taux, la distribution et les causes de mauvais résultats du test Xpert dans le but d'identifier les domaines clés qui doivent être renforcés pour une performance optimale du test.Schéma : Analyse rétrospective des données téléchargées entre janvier et décembre 2015 depuis les structures équipées de Xpert vers le serveur central à travers le GXAlert.Résultats : Sur 52 219 tests téléchargés à partir de 176 machines, 22,5% ont été positifs pour Mycobacterium tuberculosis, dont 10,8% ont été résistants à la rifampicine ; globalement, 4,7% ont été invalides, 4,2% ont eu des résultats erronés et 2,1% n'ont eu aucun résultat. Les erreurs d'origine technique ont été les plus fréquentes, à 69%, n'ont pas eu de variation saisonnière et sont survenues dans toutes les zones géopolitiques et à tous les niveaux des structures de santé. Les erreurs liées à la température ont été prévalentes dans la région nord-ouest, avec des pics d'avril à juin. Les périodes de pic en termes de température et de dysfonction des machines ont coïncidé avec les périodes de faible utilisation du test.Conclusion : Le problème principal qui a affecté la performance du test a été l'adhérence médiocre aux procédures opératoires standardisées. Des révisions périodiques de la formation, une supervision régulière, une maintenance préventive de la machine à Xpert et un stockage approprié des cartouches constituent des stratégies susceptibles d'améliorer la performance du Xpert.

Marco de referencia: Nigeria, un país con alta carga de morbilidad por tuberculosis.Objetivo: Estudiar la tasa de resultados fallidos de la prueba Xpert, su distribución y sus causas con el objeto de reconocer las esferas prioritarias que precisan fortalecimiento, a fin de obtener un funcionamiento óptimo de la prueba.Método: Fue este un análisis retrospectivo de los datos enviados al servidor central por los establecimientos que practican la prueba Xpert, mediante el sistema GXAlert, de enero a diciembre del 2015.Resultados: De 52 219 pruebas realizadas en 176 dispositivos y subidas al sistema, 22,5% fueron positivas para Mycobacterium tuberculosis y de ellas el 10,8% presentó resistencia a rifampicina; de todos los resultados, 4,7% fueron inválidos, 4,2% exhibieron error y 2,1% de las pruebas no comportaban un resultado. El error más frecuente fue el de tipo técnico (69%), el cual no siguió un carácter estacional y ocurrió en todas las regiones geopolíticas y en establecimientos de salud de todos los niveles. Los errores debidos a la temperatura predominaron en la región noroeste, con períodos de mayor frecuencia de abril a junio. Los períodos de mayor frecuencia de errores causados por la temperatura o el disfuncionamiento de los dispositivos coincidieron con épocas de baja utilización de la prueba.Conclusión: El principal problema que interfirió con el buen funcionamiento de la prueba fue el incumplimiento de los procedimientos normalizados de trabajo. Se podría mejorar la eficacia de la prueba Xpert mediante estrategias como los cursos periódicos de actualización, la supervisión constante y el mantenimiento preventivo de los dispositivos, además del almacenamiento adecuado de los cartuchos de la prueba.

Economic support intervention improves tuberculosis treatment outcomes in rural Nigeria.

SETTING: A secondary care hospital in rural Nigeria. OBJECTIVE: To investigate the feasibility of providing financial incentives to tuberculosis (TB) patients under routine conditions, and to determine their impact on TB treatment outcomes in a low-resource setting. DESIGN: A prospective, non-randomised intervention study. RESULTS: A total of 294 TB patients (respectively 173 and 121 in the control and intervention periods of 3 months' duration each) were registered in the study. The patients did not differ in terms of their demographic or clinical characteristics (P not significant). The treatment success rate was 104/121 (86.0%) during the intervention, and 123/173 (71.1%) during the control period (P = 0.003). The proportion of patients who were lost to follow-up significantly decreased during the intervention period (20.2% vs. 5.0%, P <0.001). There were no differences in deaths (P = 0.8) or treatment failure rates (P = 0.5) in the intervention and control periods. There was also no difference in the rate of sputum smear conversion after the intensive phase of treatment (88.1% vs. 91.5%, P = 0.5). Independent determinants of treatment success were female sex (adjusted odds ratio [aOR] 1.9), human immunodeficiency virus negativity (aOR 2.5) and receiving financial incentives (aOR 2.3). CONCLUSIONS: Financial incentives proved to be effective in improving treatment success and reducing loss to follow-up among poor TB patients in Nigeria.

Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding.

BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. METHODS: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. RESULTS: CWs referred 4-22% of presumptive TB clients tested, and 4-24% of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. CONCLUSION: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Estimating the cost of TB and its social impact on TB patients and their households.

Illness often poses a significant financial burden on individuals and their households, and tuberculosis (TB) is no exception. Although TB treatment is free in Nigeria, patients are likely to incur costs due to multiple visits during treatment. The purpose of this study was 1) to examine the health-seeking behaviour of TB patients and the costs borne by TB patients in Nigeria, and 2) to assess the social impact of TB disease on TB patients and their families/households. Of 260 TB patients surveyed, the majority (74.7%) were aged between 20 and 49 years. TB patients expended an average of US$52.02 (N = 8323.58, at the rate of US$1 = N = 160) per person on all visits associated with diagnosis and receipt of diagnostic test results. Overall, households experienced a shortfall of about US$57.30 (N = 9174.72) or 24.9% of income loss due to TB illness. Further analysis revealed that 9.7% of TB patients relied on children of school age or below to finance the costs of TB illness.

La maladie constitue souvent un lourd fardeau financier pour les patients et leurs familles et il en va de même pour la tuberculose (TB). Même si le traitement de la TB est gratuit au Nigéria, les patients doivent supporter les coûts liés aux nombreuses consultations pendant le traitement. Le but de cette étude a été 1) d'examiner le comportement des patients TB en matière de recherche de soins et les coûts supportés par ces patients au Nigéria, et 2) d'évaluer l'impact social de la TB maladie sur les patients et leurs familles/foyers. Sur 260 patients TB de l'enquête, la majorité (74,7%) étaient âgés de 20 à 49 ans. Ils ont dépensé en moyenne US$52,02 (8323,58 nairas nigériens, au taux de change de $1 = N = 160) par personne pour les consultations liées au diagnostic et la réception des résultats de leurs examens. Au total, les foyers ont eu un déficit d'environ US$57,30 (N = 9174,72) ou 24,9% de perte de revenus due à la maladie. Une analyse plus approfondie a révélé que 9,7% des patients TB comptaient sur les enfants d'âge scolaire ou préscolaire pour financer les coûts de la TB.

Las enfermedades suelen imponer una considerable carga económica a los pacientes y sus hogares y la tuberculosis (TB) no constituye una excepción. Aunque el tratamiento antituberculoso sea gratuito en Nigeria, con frecuencia los pacientes deben asumir los gastos que generan las múltiples consultas durante el tratamiento. El presente estudio tuvo los siguientes objetivos: 1) examinar el comportamiento de búsqueda de atención sanitaria de los pacientes aquejados de TB y los costos que sufragan estos pacientes en Nigeria; y 2) evaluar la repercusión social de la enfermedad tuberculosa sobre los pacientes, sus familias y sus hogares. De los 260 pacientes con TB que participaron en el estudio, la mayoría tenía entre 20 y 49 años de edad (74,7%). En promedio, los gastos de cada paciente por todas las consultas asociadas con el diagnóstico y la recepción de los resultados de las pruebas fue 52,02 USD (u 8323,58 nairas; 1 USD = 160 NGD). En general, debido a la enfermedad tuberculosa el ingreso de los hogares sufrió una pérdida cercana a 57,30 USD (o 9174,72 NGD) o de una disminución del 24,9%. Un análisis más detallado reveló que un 9,7% de los pacientes con TB dependía de los hijos en edad escolar o menores para financiar los costos de la enfermedad.

TUBERCULOSIS CONTROL IN SECURITY CHALLENGED STATES OF NORTH-EAST NIGERIA. ARE THERE SIGNIFICANT IMPACT?.

BACKGROUND: Nigeria in the past few years is faced with various security challenges in different parts of the country. The most severe in the last three years has been the crisis in northern Nigeria and specifically the north-eastern States, where three of the States have been under emergency rule for a year. Health care delivery system is usually one of the major casualties in a security challenged environment leading to unavailability or low utilization of services.The aim of this paper is to share the experience of TB services in states under emergency rule. METHODOLOGY: A retrospective review of program data (reportable indicators for TB case finding,TB/HIV and treatment outcome for periods of eight years (2006-2013) comparing national data with north-east and the three states most affected by security challenges (Borno, Adamawa & Yobe). RESULTS: A national positive trend on case notification for all forms of TB and smear positive, with a declined in 2011 but generally the case notification has remain low (59/100,000 in 2013 compared to estimated prevalence of 338/100,000). North east data is a negative trend for case notification and this is worse for 2 states (Borno and Yobe) while Adamawa shows and increase CNR from 2012 because of TB Reach active case, finding. Treatment success rate has a positive trend both national, north east states and in the 3 challenged states (TSR above 84%). TB/HIV indicators for north east are 81%, 75%, and 58% for HCT CPT and ART respectively, these figures has serious fluctuations within and among the three security challenged states with Borno most affected. CONCLUSIONS: Insecurity can pose a challenge for TB control activities especially case finding, therefore the need for innovative approaches for case finding in areas of insecurity. Chronic infectious diseases like TB and HIV should be incorporated into emergency responses offered by organisations and agencies for internally displaced persons.

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos, Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children. METHODS: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013. RESULTS: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1-4 years and 186 (58.1%) 5-14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05). CONCLUSION: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.

Contexte : Le virus de l'immunodéficience humaine (VIH) et la tuberculose (TB) sont les causes majeures de décès dû à une maladie infectieuse dans le monde. L'Organisation Mondiale de la Santé estime que la prévalence du VIH parmi les enfants atteints de TB dans des pays à prévalence modérée à élevée va de 10% à 60%. Cette étude a eu pour but de déterminer l'accès aux services VIH pour les enfants coinfectés par TB-VIH.Méthodes : Une revue rétrospective des données d'enfants ayant eu un diagnostic de TB dans l'état de Lagos au Nigeria entre le 1e janvier 2012 et le 31 décembre 2013.Résultats : Un total de 1199 enfants âgés de 0 à 14 ans ont eu un diagnostic de TB. Parmi eux, 1095 (91,3%) ont eu un test VIH, dont 320 (29,2%) ont été positifs. Le ratio garçon/fille de coinfection TB-VIH a été de 1:0,9. Sur les 320 enfants coinfectés TB-VIH, 57 (17,8%), 86 (26,9%) et 186 (58,1%) respectivement avaient <1 an, 1­4 ans et 5­14 ans. Sur les 320 enfants coinfectés TB-VIH, 186 (58,1%) ont débuté le cotrimoxazole (CPT) tandis que 151 (47,2%) étaient sous traitement antirétroviral (ART). La mise sous ART n'a pas été significativement plus élevée dans les structures où les services TB-VIH se trouvaient au même endroit (P > 0,05).Conclusion : La mise sous CPT et ART a été faible. Il est nécessaire d'intensifier les efforts d'amélioration de l'accès aux services VIH à Lagos, Nigeria.

Marco de referencia: La infección por el virus de la inmunodeficiencia humana (VIH) y la tuberculosis (TB) son las principales causas de muerte por enfermedad infecciosa en todo el mundo. La Organización Mundial de la Salud considera que la prevalencia de infección por el VIH en los niños con TB de los países con prevalencia moderada o alta oscila entre 10% y 60%. El presente estudio tuvo por objeto determinar el acceso de los niños coinfectados por el VIH y la TB a los servicios relacionados con el VIH.Método: Se llevó a cabo un examen retrospectivo de los datos sobre los niños con diagnóstico de TB en el estado de Lagos en Nigeria del 1° de enero del 2012 al 31 de diciembre del 2013.Resultados: Se estableció el diagnóstico de TB en 1199 niños de 0 a 14 años de edad, de los cuales 1095 contaban con una prueba diagnóstica del VIH (91,3%) y 320 habían obtenido un resultado positivo (29,2%). La proporción entre el sexo masculino y femenino fue 1:0,9 en los niños coinfectados. De los 320 casos de coinfección, 57 eran menores de un año de edad (17,8%), 86 tenían entre 1 y 4 años (26,9%) y 186 entre 5 y 14 años de edad (58,1%). De los 320 niños coinfectados, se inició tratamiento preventivo con cotrimoxazol (CPT) en 186 (58,1%) y 15 niños comenzaron el tratamiento antirretrovírico (ART) (47,2%). La aceptación del ART no fue significativamente más alta en los establecimientos donde los servicios contra la TB y el VIH compartían la ubicación (P > 0,05).Conclusión: La aceptación del CPT y el ART fue baja. Es preciso intensificar las iniciativas tendentes a mejorar el acceso a los servicios relacionados con el VIH de Lagos, en Nigeria.

Tuberculosis among nomads in Adamawa, Nigeria: outcomes from two years of active case finding.

BACKGROUND: Nomadic populations are often isolated and have difficulty accessing health care, leading to increased morbidity and mortality. Although Nigeria has one of the highest tuberculosis (TB) burdens in Africa, case detection rates remain relatively low. METHODS: Active case finding for TB among nomadic populations was implemented over a 2-year period in Adamawa State. A total of 378 community screening days were organised with local leaders; community volunteers provided treatment support. Xpert(®) MTB/RIF was available for nomads with negative smear results. RESULTS: Through active case finding, 96 376 nomads were verbally screened, yielding 1310 bacteriologically positive patients. The number of patients submitting sputum for smear microscopy statewide increased by 112% compared with the 2 years before the intervention. New smear-positive notifications increased by 49.5%, while notifications of all forms of TB increased by 24.5% compared with expected notifications based on historical trends. Nomads accounted for respectively 31.4% and 26.0% of all smear-positive and all forms TB notifications. Pre-treatment loss to follow-up and treatment outcomes were similar among nomads and non-nomads. DISCUSSION: Nomads in Nigeria have high TB rates, and active case-finding approaches may be useful in identifying and successfully treating them. Large-scale interventions in vulnerable populations can improve TB case detection.

Tuberculosis case management and treatment outcome: assessment of the effectiveness of Public-Private Mix of tuberculosis programme in Kaduna State, Nigeria.

BACKGROUND: In an effort to increase tuberculosis (TB) case detection, the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. METHODS: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. RESULTS: Except for the lower use of sputum microscopy for diagnosis, adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients, an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities, 13.1% and 12.2% respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7%) compared to 78.6% in the public health facilities. CONCLUSION: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated.

Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public - Private Mix of Tuberculosis Programme in Kaduna State; Nigeria

Background: In an effort to increase tuberculosis (TB) case detection; the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis; adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients; an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities; 13.1and 12.2respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7) compared to 78.6in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated

Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public - Private Mix of Tuberculosis Programme in Kaduna State; Nigeria

Background: In an effort to increase tuberculosis (TB) case detection; the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis; adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients; an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities; 13.1and 12.2respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7) compared to 78.6in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated