Scale-up of collaborative TB/HIV activities in Guyana.

OBJECTIVE: To assess scale-up of recommended tuberculosis (TB)/HIV activities in Guyana and to identify specific strategies for further expansion. METHODS: Medical records and clinic registers were reviewed at nine TB clinics and 10 HIV clinics. At TB clinics, data were collected on HIV testing and antiretroviral therapy (ART) for patients with TB/HIV; at HIV clinics, data were collected on intensified case finding (ICF), tuberculin skin test (TST) results, and provision of isoniazid preventive therapy (IPT). RESULTS: At TB clinics, among 461 patients newly diagnosed with TB, 419 (90.9%) had a known HIV status and 121 (28.9%) were HIV-infected. Among the 63 patients with TB/HIV, 33 (52.4%) received ART. Among the 45 patients with TB/HIV for whom dates of HIV diagnosis were available, 38 (84.4%) individuals knew their HIV status prior to TB diagnosis. At HIV clinics, among 127 patients eligible to receive a TST, 87 (68.5%) received a TST, 66 (75.9%) had a TST result, seven (10.6%) had a newly positive result, two had a previously positive result, and six of nine patients with positive results (66.7%) received IPT. ICF could not be assessed because of incomplete or discrepant documentation. CONCLUSIONS: An in-depth evaluation of TB/HIV activities successfully identified areas of success and remaining challenges. At TB clinics, HIV testing rates are high; further scale-up of ART for persons with TB/HIV is needed. At HIV clinics, use of TST to focus IPT is a feasible and efficient strategy; improving rates of annual TST screening will allow for further expansion of IPT.

Scale-up of collaborative TB/HIV activities in Guyana / Ampliar las actividades de colaboración contra la tuberculosis y la infección por el VIH en Guyana

Objective. To assess scale-up of recommended tuberculosis (TB)/HIV activities in Guyana and to identify specific strategies for further expansion. Methods. Medical records and clinic registers were reviewed at nine TB clinics and 10 HIV clinics. At TB clinics, data were collected on HIV testing and antiretroviral therapy (ART) for patients with TB/HIV; at HIV clinics, data were collected on intensified case finding (ICF), tuberculin skin test (TST) results, and provision of isoniazid preventive therapy (IPT). Results. At TB clinics, among 461 patients newly diagnosed with TB, 419 (90.9%) had a known HIV status and 121 (28.9%) were HIV-infected. Among the 63 patients with TB/HIV, 33 (52.4%) received ART. Among the 45 patients with TB/HIV for whom dates of HIV diagnosis were available, 38 (84.4%) individuals knew their HIV status prior to TB diagnosis. At HIV clinics, among 127 patients eligible to receive a TST, 87 (68.5%) received a TST, 66 (75.9%) had a TST result, seven (10.6%) had a newly positive result, two had a previously positive result, and six of nine patients with positive results (66.7%) received IPT. ICF could not be assessed because of incomplete or discrepant documentation. Conclusions. An in-depth evaluation of TB/HIV activities successfully identified areas of success and remaining challenges. At TB clinics, HIV testing rates are high; further scale-up of ART for persons with TB/HIV is needed. At HIV clinics, use of TST to focus IPT is a feasible and efficient strategy; improving rates of annual TST screening will allow for further expansion of IPT.

Objetivo. Evaluar la ampliación de las actividades recomendadas contra la tuberculosis (TB) y la infección por el VIH en Guyana y definir estrategias específicas para nuevas expansiones. Métodos. Se examinaron los expedientes médicos y registros clínicos de nueve consultorios de atención de la TB y diez consultorios de atención de la infección por el VIH. En los consultorios de atención de la tuberculosis, se recopilaron datos sobre las pruebas de detección del VIH y el tratamiento antirretroviral (TAR) para pacientes con TB e infección por el VIH; en los consultorios de atención de la infección por VIH, se recopilaron datos a partir de una búsqueda intensiva de casos, los resultados de la prueba de la tuberculina y la provisión de tratamiento preventivo con isoniazida. Resultados. En los consultorios de atención de la tuberculosis, de 461 pacientes recién diagnosticados con tuberculosis, 419 (90,9%) conocían su estado con respecto a la infección por el VIH y 121 (28,9%) estaban infectados por el virus. De los 63 pacientes con TB e infección por el VIH, 33 (52,4%) recibieron TAR. De los 45 pacientes con TB e infección por el VIH cuya fecha de diagnóstico de la infección por el VIH se conocía, 38 (84,4%) supieron de su estado con respecto a la infección por el VIH antes de recibir el diagnóstico de la tuberculosis. En los consultorios de atención de la infección por el VIH, de 127 pacientes que reunían los requisitos para la prueba de la tuberculina, 87 (68,5%) recibieron la prueba, 66 (75,9%) tuvieron un resultado, siete (10,6%) tuvieron un resultado positivo nuevo, dos habían tenido un resultado positivo anteriormente, y seis de nueve pacientes con resultados positivos (66,7%) recibieron tratamiento preventivo con isoniazida. No pudo evaluarse la búsqueda intensiva de casos debido a que la documentación estaba incompleta o era discrepante. Conclusiones. Una evaluación exhaustiva de las actividades contra la TB y la infección por el VIH permitió determinar las áreas donde se había tenido éxito y los retos pendientes. En los consultorios de atención de la tuberculosis, las tasas de realización de pruebas de detección del VIH son elevadas; se necesita ampliar el alcance del TAR para llegar a las personas con TB e infección por el VIH. En los consultorios de atención de la infección por el VIH, el uso de la prueba de la tuberculina para focalizar la búsqueda intensiva de casos es una estrategia factible y eficaz; el mejoramiento de las tasas de tamizaje anual con la prueba de la tuberculina permitirá ampliar la búsqueda intensiva de casos.

Scale-up of collaborative TB/HIV activities in Guyana / Ampliar las actividades de colaboración contra la tuberculosis y la infección por el VIH en Guyana

ABSTRACT Objective To assess scale-up of recommended tuberculosis (TB)/HIV activities in Guyana and to identify specific strategies for further expansion. Methods Medical records and clinic registers were reviewed at nine TB clinics and 10 HIV clinics. At TB clinics, data were collected on HIV testing and antiretroviral therapy (ART) for patients with TB/HIV; at HIV clinics, data were collected on intensified case finding (ICF), tuberculin skin test (TST) results, and provision of isoniazid preventive therapy (IPT). Results At TB clinics, among 461 patients newly diagnosed with TB, 419 (90.9%) had a known HIV status and 121 (28.9%) were HIV-infected. Among the 63 patients with TB/HIV, 33 (52.4%) received ART. Among the 45 patients with TB/HIV for whom dates of HIV diagnosis were available, 38 (84.4%) individuals knew their HIV status prior to TB diagnosis. At HIV clinics, among 127 patients eligible to receive a TST, 87 (68.5%) received a TST, 66 (75.9%) had a TST result, seven (10.6%) had a newly positive result, two had a previously positive result, and six of nine patients with positive results (66.7%) received IPT. ICF could not be assessed because of incomplete or discrepant documentation. Conclusions An in-depth evaluation of TB/HIV activities successfully identified areas of success and remaining challenges. At TB clinics, HIV testing rates are high; further scale-up of ART for persons with TB/HIV is needed. At HIV clinics, use of TST to focus IPT is a feasible and efficient strategy; improving rates of annual TST screening will allow for further expansion of IPT.

RESUMEN Objetivo Evaluar la ampliación de las actividades recomendadas contra la tuberculosis (TB) y la infección por el VIH en Guyana y definir estrategias específicas para nuevas expansiones. Métodos Se examinaron los expedientes médicos y registros clínicos de nueve consultorios de atención de la TB y diez consultorios de atención de la infección por el VIH. En los consultorios de atención de la tuberculosis, se recopilaron datos sobre las pruebas de detección del VIH y el tratamiento antirretroviral (TAR) para pacientes con TB e infección por el VIH; en los consultorios de atención de la infección por VIH, se recopilaron datos a partir de una búsqueda intensiva de casos, los resultados de la prueba de la tuberculina y la provisión de tratamiento preventivo con isoniazida. Resultados En los consultorios de atención de la tuberculosis, de 461 pacientes recién diagnosticados con tuberculosis, 419 (90,9%) conocían su estado con respecto a la infección por el VIH y 121 (28,9%) estaban infectados por el virus. De los 63 pacientes con TB e infección por el VIH, 33 (52,4%) recibieron TAR. De los 45 pacientes con TB e infección por el VIH cuya fecha de diagnóstico de la infección por el VIH se conocía, 38 (84,4%) supieron de su estado con respecto a la infección por el VIH antes de recibir el diagnóstico de la tuberculosis. En los consultorios de atención de la infección por el VIH, de 127 pacientes que reunían los requisitos para la prueba de la tuberculina, 87 (68,5%) recibieron la prueba, 66 (75,9%) tuvieron un resultado, siete (10,6%) tuvieron un resultado positivo nuevo, dos habían tenido un resultado positivo anteriormente, y seis de nueve pacientes con resultados positivos (66,7%) recibieron tratamiento preventivo con isoniazida. No pudo evaluarse la búsqueda intensiva de casos debido a que la documentación estaba incompleta o era discrepante. Conclusiones Una evaluación exhaustiva de las actividades contra la TB y la infección por el VIH permitió determinar las áreas donde se había tenido éxito y los retos pendientes. En los consultorios de atención de la tuberculosis, las tasas de realización de pruebas de detección del VIH son elevadas; se necesita ampliar el alcance del TAR para llegar a las personas con TB e infección por el VIH. En los consultorios de atención de la infección por el VIH, el uso de la prueba de la tuberculina para focalizar la búsqueda intensiva de casos es una estrategia factible y eficaz; el mejoramiento de las tasas de tamizaje anual con la prueba de la tuberculina permitirá ampliar la búsqueda intensiva de casos.

Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes.

BACKGROUND: In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis. METHODOLOGY: During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article. RESULTS: The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed. CONCLUSIONS: Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.

A needs assessment of clients with HIV in a home-based care program in Guyana.

OBJECTIVE: To assess the needs of clients in a home-based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara-Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers. DESIGN AND SAMPLE: A cross-sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross-sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana. MEASURES: Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse. RESULTS: The services most commonly received by respondents included nutritional assessment and counseling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adherence, and support for HIV disclosure. Respondents reported further need of referrals to income-generation opportunities, food and nutritional supplement support, and support for children. Forty-two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem. CONCLUSIONS: While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income-generation opportunities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV.

Solid state NMR studies of photoluminescent cadmium chalcogenide nanoparticles.

Solid state (113)Cd, (77)Se, (13)C and (31)P NMR have been used to study a number of Cd chalcogenide nanoparticles synthesized in tri-n-octyl-phosphine (TOP) with different compositions and architectures. The pure CdSe and CdTe nanoparticles show a dramatic, size-sensitive broadening of the (113)Cd NMR line, which can be explained in terms of a chemical shift distribution arising from multiple Cd environments. From (13)C NMR, it has been discovered that TOP, or its derivatives such as TOPO (trioctylphosphine oxide), is rapidly moving about the surface of the nanoparticles, indicating that it is relatively weakly bound as compared to other materials used as surface ligands, such as hexadecylamine. (31)P NMR of the nanoparticles shows at least five species arising from coordination of the ligands to different surface sites. (113)Cd NMR of CdSeTe alloy and layered nanoparticles has provided crucial information which, in conjunction with results from other techniques (especially optical characterization), has made it possible to develop a detailed picture of the composition and structure of these materials: (i) a true CdSeTe homogeneous alloy nanoparticle, (ii) a nanoparticle segregated into an alloy core region rich in Te, with a CdSeTe (close to 1 : 1 Se : Te) alloy shell and (iii) a CdSe/CdTe/CdSe layered nanoparticle in which the CdTe layer contains a small amount of Se and which forms a Quantum Dot Quantum Well (QDQW) system. The results demonstrate that solid state NMR is a vital tool in the arsenal of characterisation techniques available for nanomaterials.

Health workers' agreement in clinical description of filarial lymphedema.

Severity of lymphedema and presence of entry lesions are risk factors for acute bacterial dermatolym-phangioadenitis (ADLA) in those with filarial lymphedema. Recurrent ADLA causes acute morbidity and progression of lymphedema severity; however, there is little work assessing the ability of health workers to reliably stage disease severity and identify risk entry lesions. This knowledge is important in initiation of management and assessing interventions. We evaluated inter-rater reliability with two independent health workers rating both legs of 17 patients using a questionnaire and the Dreyer classification of lymphedema. The health workers could reliably stage lymphedema with high agreement (RMAC weighted kappa of 0.89) and identify nail, interdigital, and other skin lesions. However, there was less consistency in identifying the clinical nature of skin lesions. This indicates that the Dreyer classification can be a replicable way to stage lymphedema and a questionnaire can deliver high observer agreement on the presence of risk lesions.

Colloidal CdSe nanocrystals from tri-n-octylphosphine: Part 1: growth and optical properties from polar and non-polar solvents.

This manuscript reports the ready synthesis of high-quality colloidal CdSe nanocrystals from tri-n-octylphosphine (TOP) and reports the optical properties of the resulting CdSe dispersed in nonpolar and polar environments. With cadmium oxide (CdO) as the Cd precursor and TOPSe as the Se source, the CdSe nanocrystals were synthesized in a reaction medium consisting of TOP. The synthetic approach is as simple as: the swift injection of a TOPSe/TOP solution into a CdO/TOP solution at one particular (high) temperature, with subsequent growth at a lower temperature. The temporal evolution of the optical properties, including absorption and luminescence, were monitored in detail. The photoluminescence (PL) properties of the TOP-capped CdSe investigated comprise the intensity, emission peak wavelength, full width at half maximum of the PL spectra, and stability; these PL properties are sensitive to the history of growth as well as the environment of dispersion. An appropriate parameter, termed "Sensitivity Index (SI)," is proposed to define the percent difference in the PL intensity that arises when the dots are dispersed in non-polar hexane (Hex) as compared to polar tetrahydrofuran (THF). The decrease in the PL efficiency on going from Hex to THF is attributed to changes in surface states rather than in the internal core as more ligands are removed in THF. Dilution experiments further confirm the suggestion of the ligand removal mechanism and provide a conceptual estimate of surface quality via the SI parameter. Due to a slow growth in size (the size of the nanocrystals is almost constant during early 20 min) and good PL stability (tested as PL changes after storage for days both in dispersed or solid states, as well as after UV-irradiation), we suggest that our synthetic approach is likely to be practical for large-scale CdSe nanocrystals with good PL stability.

Effect of reaction media on the growth and photoluminescence of colloidal CdSe nanocrystals.

Using cadium oxide (CdO) as the Cd precursor and tri-n-octylphosphine selenide (TOPSe) as the Se source, TOP-capped and TOP/tri-n-octylphosphine oxide (TOPO)-capped CdSe nanocrystals were synthesized without the use of an acid. The synthetic approach involved the addition of a TOPSe/TOP solution into a CdO/TOP solution with or without TOPO at one temperature and subsequent growth at a lower temperature. The temporal evolution of the optical properties, namely, absorption and luminescence, of the growing nanocrystals was monitored in detail. A comprehensive examination on the control of the photoluminescence (PL) properties was performed by systematically varying the TOP/TOPO weight ratio of the reaction media. Surprisingly, a rational choice of 100% TOP or 80% TOP was found to produce "quality" nanocrystals when monitored under the present experimental conditions and growth-time scale. The term "quality" is mainly based on the sharp features and rich substructure exhibited in the absorption spectra of the growing nanocrystals, as well as the sharp features in the emission spectra with narrow full width at half-maximum (fwhm). There are two distinguishable stages of growth: an early stage (<5 min) and a later stage. TOP plays a major role in the control of a slow growth rate in the early stage, while TOPO controls slow growth in the later stage. The optical sensitivity of the growing nanocrystals when dispersed in nonpolar or polar solvents was studied, including two size-dependent parameters, namely, the solvent sensitivity (PL intensity) and nonresonant Stokes shift (NRSS). The insights gained from the present study enable a synthetic approach in which high-quality CdSe nanocrystals are achieved with high synthetic reproducibility.