Characteristics of TPT initiation and completion among people living with HIV.

BACKGROUND: TB preventive treatment (TPT) reduces morbidity and mortality among people living with HIV (PLHIV). Despite the successful scale-up of TPT in Malawi, monitoring and evaluation have been suboptimal. We utilized the Malawi Population-Based HIV Impact Assessment (MPHIA) 2020-2021 survey data to estimate TPT uptake and completion among self-reported HIV-positive persons. METHODS: We estimated the proportion of HIV-positive respondents who had ever undergone TPT, and determined the percentage of those currently on TPT who had completed more than 6 months of treatment. Bivariate and multivariable logistic regression were performed to calculate the odds ratios for factors associated with ever-taking TPT. All variables were self-reported, and the analysis was weighted and accounted for in the survey design. RESULTS: Of the HIV+ respondents, 38.8% (95% CI 36.4-41.3) had ever taken TPT. The adjusted odds of ever taking TPT were 8.0 and 5.2 times as high in the Central and Southern regions, respectively, compared to the Northern region; 1.9 times higher among those in the highest wealth quintile, and 2.1 times higher for those on antiretroviral therapy >10 years. Of those currently taking TPT, 56.2% completed >6 months of TPT. CONCLUSION: These results suggest low TPT uptake and >6 months' completion rates among self-reported HIV+ persons. Initiatives to create demand and strengthen adherence would improve TPT uptake.

CONTEXTE: Le traitement préventif de la TB (TPT) réduit la morbidité et la mortalité chez les personnes vivant avec le VIH (PVVIH). Malgré l'extension réussie du TPT au Malawi, le suivi et l'évaluation n'ont pas été optimaux. Nous avons utilisé les données de l'enquête MPHIA (Malawi Population-Based HIV Impact Assessment) 2020­2021 pour estimer l'adoption et l'achèvement du TPT parmi les personnes se déclarant séropositives. MÉTHODES: Nous avons estimé la proportion de répondants séropositifs qui avaient déjà subi un TPT et déterminé le pourcentage de ceux qui sont actuellement sous TPT et qui ont terminé plus de 6 mois de traitement. Une régression logistique bivariée et multivariable a été effectuée pour calculer les rapports de cotes des facteurs associés au fait d'avoir déjà pris un TPT. Toutes les variables étaient autodéclarées et l'analyse a été pondérée et prise en compte dans la conception de l'enquête. RÉSULTATS: Parmi les répondants séropositifs, 38,8% (IC 95% 36,4­41,3) avaient déjà pris du TPT. Les probabilités ajustées de prise de TPT étaient 8,0 et 5,2 fois plus élevées dans les régions du centre et du sud, respectivement, que dans la région du nord ; 1,9 fois plus élevées chez les personnes appartenant au quintile de richesse le plus élevé, et 2,1 fois plus élevées chez les personnes suivant une thérapie antirétrovirale depuis plus de 10 ans. Parmi ceux qui prennent actuellement un TPT, 56,2% ont terminé >6 mois de TPT. CONCLUSION: Ces résultats suggèrent un faible taux d'utilisation du TPT et des taux d'achèvement de >6 mois parmi les personnes déclarées séropositives. Des initiatives visant à créer une demande et à renforcer l'adhésion permettraient d'améliorer l'utilisation du TPT.

Wheat rust epidemics damage Ethiopian wheat production: A decade of field disease surveillance reveals national-scale trends in past outbreaks.

Wheat rusts are the key biological constraint to wheat production in Ethiopia-one of Africa's largest wheat producing countries. The fungal diseases cause economic losses and threaten livelihoods of smallholder farmers. While it is known that wheat rust epidemics have occurred in Ethiopia, to date no systematic long-term analysis of past outbreaks has been available. We present results from one of the most comprehensive surveillance campaigns of wheat rusts in Africa. More than 13,000 fields have been surveyed during the last 13 years. Using a combination of spatial data-analysis and visualization, statistical tools, and empirical modelling, we identify trends in the distribution of wheat stem rust (Sr), stripe rust (Yr) and leaf rust (Lr). Results show very high infection levels (mean incidence for Yr: 44%; Sr: 34%; Lr: 18%). These recurrent rust outbreaks lead to substantial economic losses, which we estimate to be of the order of 10s of millions of US-D annually. On the widely adopted wheat variety, Digalu, there is a marked increase in disease prevalence following the incursion of new rust races into Ethiopia, which indicates a pronounced boom-and-bust cycle of major gene resistance. Using spatial analyses, we identify hotspots of disease risk for all three rusts, show a linear correlation between altitude and disease prevalence, and find a pronounced north-south trend in stem rust prevalence. Temporal analyses show a sigmoidal increase in disease levels during the wheat season and strong inter-annual variations. While a simple logistic curve performs satisfactorily in predicting stem rust in some years, it cannot account for the complex outbreak patterns in other years and fails to predict the occurrence of stripe and leaf rust. The empirical insights into wheat rust epidemiology in Ethiopia presented here provide a basis for improving future surveillance and to inform the development of mechanistic models to predict disease spread.

Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014-2016.

Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities.

Contexte : Structures de santé publiques offrant des services de la tuberculose (TB) et du virus de l'immunodéficience humaine (VIH) au Malawi.Objectifs : Utilisant des données recueillies en routine de prestation des services de santé, décrire les tendances de la vérification du VIH et de l'utilisation du test Xpert® MTB/RIF afin de diagnostiquer la TB parmi les cas présumés de TB qui sont VIH positifs.Schéma : Etude de mise en œuvre des cas présumés de TB qui ont sollicité des soins dans 21 structures entre avril 2014 et juin 2016. Nous avons utilisé des statistiques descriptives pour résumer les caractéristiques des patients, des structures et des services.Résultats : Sur les 28 567 cas présumés de TB qui ont été analysés, 23 198 (81%) connaissaient leur statut VIH. La proportion de statuts VIH vérifiés parmi les cas de TB présumés a augmenté tout au long de la période d'étude. La prévalence du VIH a été de 49%, avec 73% des patients VIH positifs présumés TB sous traitement antirétroviral. L'accès à Xpert était entre 37% et 63% par trimestre parmi les patients VIH positifs présumés TB avec des résultats de frottis de crachats négatifs. Sur les 7829 patients ayant des résultats documentés d'Xpert, 68% ont été VIH positifs.Conclusion : Après l'introduction des registres comportant des variables liées au statut VIH, la constatation du VIH parmi les cas présumés de TB a augmenté dans le temps. L'accès à Xpert a été sous-optimal parmi les cas de TB présumés VIH-positifs. Davantage de collaboration entre les programmes nationaux TB et VIH pourrait faciliter une utilisation accrue d'Xpert pour les patients VIH positifs avec une présomption de TB qui sollicitent des soins dans des structures de santé publiques.

Marco de referencia: Los establecimientos públicos de atención de salud que prestan servicios relacionados con la tuberculosis (TB) y la infección por el virus de la inmunodeficiencia humana (VIH) en Malawi.Objetivos: A partir de los datos recogidos de manera sistemática sobre la prestación de los servicios de salud, describir la evolución de la determinación de la situación frente al VIH y de la utilización de la prueba Xpert® MTB/RIF para el diagnóstico de TB, en los casos positivos frente al VIH con presunción clínica de esta enfermedad.Método: Se llevó a cabo un estudio de implementación de los casos con presunción de TB que buscaron atención en 21 centros, de abril 2014 a junio 2016. Se utilizaron estadísticas descriptivas a fin de resumir las características de los pacientes, los establecimientos y los servicios.Resultados: De los 28 567 casos con presunción de TB analizados, 23 198 conocían su situación frente al VIH (81%). La proporción de determinación de la situación frente al VIH en los casos analizados aumentó durante el período del estudio. La prevalencia de infección por el VIH fue 49% y el 73% de estos casos recibía tratamiento antirretrovírico. El acceso a la prueba Xpert osciló entre 37% y 63% por trimestre en los pacientes positivos frente al VIH con presunción de TB y resultados negativos de la baciloscopia de esputo. De los 7829 pacientes con resultado de la prueba Xpert, en el 68% la prueba fue positiva.Conclusión: Tras la introducción de los registros que comportan variables relacionadas con el VIH, la determinación de la situación frente al VIH en los casos con presunción de TB ha aumentado en el transcurso del tiempo. El acceso a la prueba Xpert fue deficiente en los pacientes positivos frente al VIH, con presunción clínica de TB. Una mayor colaboración entre los programas nacionales contra la TB y el VIH facilitaría la utilización de la prueba Xpert en los pacientes seropositivos con presunción de TB que buscan atención en los centros públicos de atención de salud.

The Yield of Community-Based "Retrospective" Tuberculosis Contact Investigation in a High Burden Setting in Ethiopia.

OBJECTIVE: To determine the yield and determinants of retrospective TB contact investigation in selected zones in Ethiopia. MATERIALS AND METHODS: This was a community-based cross-sectional study conducted during June-October 2014.Trained lay providers performed symptom screening for close contacts of index cases with all types of TB registered for anti-TB treatment within the last three years. We used logistic regression to determine factors associated with TB diagnosis among the contacts. RESULTS: Of 272,441 close contacts of 47, 021 index cases screened, 13,886 and 2, 091 had presumptive and active TB respectively. The yield of active TB was thus 768/100, 000, contributing 25.4% of the 7,954 TB cases reported from the study zones over the study period. The yield was highest among workplace contacts (12,650/100, 000). Active TB was twice more likely among contacts whose index cases had been registered for TB treatment within the last 12 months compared with those who had been registered 24 or more months earlier (adjusted odds ratio, AOR: 1.77 95% CI 1.42-2.21). Sex or clinical type of TB in index cases was not associated with the yield. Smear negative (SS-) index cases (AOR: 1.74 955 CI 1.13-2.68), having index cases who registered for treatment within <12 months (AOR: 2.41 95% CI 1.51-3.84) and being household contact (AOR: 0.072 95% CI 0.01-0.52) were associated with the occurrence of active TB in children. CONCLUSIONS: The yield of retrospective contact investigation was about six times the case notification in the study zones, contributing a fourth of all TB cases notified over the same period. The yield was highest among workplace contacts and in those with recent past history of contact. Retrospective contact screening can serve as additional strategy to identify high risk groups not addressed through currently recommended screening approaches.

Trends in tuberculosis case notification and treatment outcomes after interventions in 10 zones of Ethiopia.

SETTING: Amhara and Oromia Regions, Ethiopia. OBJECTIVE: To determine trends in case notification rates (CNRs) among new tuberculosis (TB) cases and treatment outcomes of sputum smear-positive (SS+) patients based on geographic setting, sex and age categories. METHODS: We undertook a trend analysis over a 4-year period among new TB cases reported in 10 zones using a trend test, a mean comparison t-test and one-way analysis of variance. RESULTS: The average CNR per 100 000 population was 128.9: 126.4 in Amhara and 131.4 in Oromia. The CNR in the project-supported zones declined annually by 6.5%, compared with a 14.5% decline in Tigray, the comparator region. TB notification in the intervention zones contributed 26.1% of the national TB case notification, compared to 13.3% before project intervention. The overall male-to-female ratio was 1.2, compared to 0.8 among SS+ children, with a female preponderance. Over 4 years, the cure rate increased from 75% to 88.4%, and treatment success from 89% to 93%. Default, transfer out and mortality rates declined significantly. CONCLUSION: Project-supported zones had lower rates of decline in TB case notification than the comparator region; their contribution to national case finding increased, and treatment outcomes improved significantly. High SS+ rates among girls deserve attention.

Scale-up of ART in Malawi has reduced case notification rates in HIV-positive and HIV-negative tuberculosis.

Setting: For 30 years, Malawi has experienced a dual epidemic of human immunodeficiency virus (HIV) infection and tuberculosis (TB) that has recently begun to be attenuated by the scale-up of antiretroviral therapy (ART). Objective: To report on the correlation between ART scale-up and annual national TB case notification rates (CNR) in Malawi, stratified by HIV-positive and HIV-negative status, from 2005 to 2015. Design: A retrospective descriptive ecological study using aggregate data from national reports. Results: From 2005 to 2015, ART was scaled up in Malawi from 28 470 to 618 488 total patients, with population coverage increasing from 2.4% to 52.2%. During this time, annual TB notifications declined by 35%, from 26 344 to 17 104, and the TB CNR per 100 000 population declined by 49%, from 206 to 105. HIV testing uptake increased from 51% to 92%. In known HIV-positive TB patients, the CNR decreased from a high of 1247/100 000 to 710/100 000, a 43% decrease. In known HIV-negative TB patients, the CNR also decreased, from a high of 66/100 000 to 49/100 000, a 26% decrease. Conclusion: TB case notifications have continued to decline in association with ART scale-up, with the decline seen more in HIV-positive than HIV-negative TB. These findings have programmatic implications for national TB control efforts.

Contexte : Pendant 30 ans, le Malawi a connu une double épidémie du virus de l'immunodéficience humaine (VIH) et de la tuberculose (TB) qui s'est atténuée récemment avec l'expansion du traitement antirétroviral (TAR).Objectif : Etablir la corrélation entre l'expansion du TAR et les notifications annuelles de cas de TB, stratifiés en fonction de leur statut VIH positif ou négatif, au Malawi, de 2005 à 2015.Schéma : Une étude rétrospective descriptive écologique reposant sur les données agrégées des rapports nationaux.Résultats : De 2005 à 2015, le Malawi a étendu le TAR de 28 470 à 618 488 patients, avec une couverture de la population passant de 2,4% à 52,2%. Pendant ce temps, les notifications annuelles de TB ont décliné de 35%, de 26 344 à 17 104, et le taux de notification des cas de TB par 100 000 population a décliné de 49%, de 206 à 105. L'utilisation du test VIH a augmenté de 51% à 92%. Chez les patients TB-VIH positifs, les taux de notification des cas ont diminué d'un niveau élevé de 1247/100 000 à 710/100 000 (diminution de 43%). Chez les patients TB-VIH négatifs connus, les taux de notification des cas ont également décru d'un taux élevé de 66/100 000 à 49/100 000 (diminution de 26%).Conclusion : Les notifications de cas de TB ont continué à décliner en association avec l'expansion du TAR, avec un déclin davantage constaté chez les patients TB-VIH positifs que chez les patients TB-VIH négatifs. Ces constatations ont des implications pour les programmes nationaux de lutte contre la TB.

Marco de referencia: Durante 30 años se ha presentado en Malawi una epidemia doble de infección por el virus de la inmunodeficiencia humana (VIH) y tuberculosis (TB), que se ha moderado en tiempos recientes gracias a la ampliación de escala de administración del tratamiento antirretrovírico (TAR).Objetivo: Evaluar la relación entre la ampliación de escala del TAR y la tasa anual nacional de notificación de casos de TB, estratificada por la situación frente al VIH, en Malawi del 2005 al 2015.Método: Fue este un estudio retrospectivo descriptivo ecológico a partir de los datos agregados de notificación a escala nacional.Resultados: Del 2005 al 2015 se amplió la escala de administración del TAR en Malawi de 28 470 a 618 488 casos, con un aumento de la cobertura del 2,4% al 52,2% de la población. Durante este período disminuyó un 35% la notificación anual de TB, de 26 344 a 17 104 casos, y un 49% la tasa de notificación, que pasó de 206 por 100 000 habitantes a 105/100 000. La aceptación de la prueba diagnóstica del VIH aumentó del 51% al 92%. En los pacientes positivos frente al VIH, la tasa de notificación de TB disminuyó de 1 247/100 000 a 710/100 000 (disminución del 43%). En los pacientes negativos frente al VIH, las tasas de notificación de TB también disminuyeron de 66/100 000 a 49/100 000 (disminución del 26%).Conclusión: La notificación de casos de TB ha continuado su disminución en paralelo con la ampliación de escala de administración del TAR; la disminución es mayor en los pacientes positivos frente al VIH que en los pacientes negativos. Estos resultados tienen consecuencias programáticas sobre las iniciativas nacionales de control de la TB.

The yield of a tuberculosis household contact investigation in two regions of Ethiopia.

SETTING: Amhara and Oromia regions, Ethiopia. OBJECTIVE: To determine the yield of a household contact investigation for tuberculosis (TB) under routine programme conditions. DESIGN: Between April 2013 and March 2014, TB clinic officers conducted symptom-based screening for household contacts (HHCs) of 6015 smear-positive TB (SS+ TB) index cases. Based on quarterly reported programme data, we calculated the yield in terms of number needed to screen (NNS) and number needed to test (NNT). RESULTS: Of 15,527 HHCs screened, 6.1% had presumptive TB (8.5% in Oromia vs. 3.9% in Amhara). All forms of TB and SS+ TB were diagnosed in respectively 2.5% (Oromia 3.9% vs. Amhara 1.2%) and 0.76% (Oromia 0.98% vs. Amhara 0.55%) of contacts. The NNS to detect a TB case all forms and SS+ TB was respectively 40 and 132. The NNT to diagnose a TB case all forms and SS+ TB was respectively 2.4 and 8. Of 1687 eligible children aged <5 years, 323 were started on isoniazid preventive therapy. CONCLUSIONS: The yield of the household contact investigation was over 10 times higher than the estimated prevalence in the general population; household contact investigations can serve as an entry point for childhood TB care.

Prevalence of Metabolic Syndrome among Working Adults in Ethiopia.

Objective. To evaluate the prevalence of metabolic syndrome (MetS) according to the International Diabetes Federation (IDF) and Adult Treatment Panel (ATP) III criteria among working East African adults. Design. This cross-sectional study of 1,935 individuals (1,171 men and 764 women) was conducted among working adults in Addis Ababa, Ethiopia. The study was conducted in accordance with the STEPwise approach of the World Health Organization. Results. According to ATP III and IDF definitions, the overall prevalence of MetS was 12.5% and 17.9%, respectively. Using ATP III criteria, the prevalence of MetS was 10.0% in men and 16.2% in women. Application of the IDF criteria resulted in a MetS prevalence of 14.0% in men and 24.0% in women. The most common MetS components among women were reduced high-density lipoprotein-cholesterol (HDL-C) (23.2%) and abdominal obesity (19.6%); whilst reduced HDL-C concentrations (23.4%) and high blood pressure (21.8%) were most common among men. Conclusion. MetS and its individual components are prevalent among an apparently healthy working population in Ethiopia. These findings indicate the need for evidence-based health promotion and disease prevention programs; and more robust efforts directed towards the screening, diagnosis and management of MetS and its components among Ethiopian adults.