15 research outputs found
Isoniazid preventive therapy completion between July-September 2019: A comparison across HIV differentiated service delivery models in Uganda
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https://doi.org/10.1371/journal.pone.0296239Background
Tuberculosis (TB) remains the leading cause of death among people living with HIV
(PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid
Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective
way of delivering ART. DSD models include Community Drug Distribution Point
(CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management
(FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is
known about the impact of delivering IPT through DSD.
Methods
We reviewed medical records of PLHIV who initiated IPT between June-September 2019 at
TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH).
We defined IPT completion as completing a course of isoniazid within 6–9 months. We utilized
a modified Poisson regression to compare IPT completion across DSD models and
determine factors associated with IPT completion in each DSD model.
Results
Data from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females:
60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen:
61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile
range [IQR]; 32.3–50.2) and 6.0 (IQR: 3.7–8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8–93.7%); highest in CDDP (98.1%, 95%CI: 95.0–99.3%) and lowest
in FBG (85.8%, 95%CI: 79.0–90.7%). Compared to FBIM, IPT completion was significantly
higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09–1.22) and CCLAD
(aRR = 1.09, 95% CI 1.02–1.16). In facility-based models, IPT completion differed between
sites (p<0.001). IPT completion increased with age for FBIM and CCLAD and was lower
among female participants in the CCLAD (aRR = 0.82, 95%CI 0.67–0.97).
Conclusion
IPT completion was high overall but highest in community-based models. Our findings provide
evidence that supports integration of IPT within DSD models for ART delivery in
Uganda and similar settings.This project was funded by the Ugandan
Ministry of Health and by grant # OPP1152764
from the Bill & Melinda Gates Foundation. The
funders had no role in study design, data collection
and analysis, decision to publish, or preparation of
the manuscript
Return to care of children and adolescents living with HIV who missed their clinic visits or were lost to follow- up: a continuous quality improvement study in Uganda
No full textThis is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non- commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.Background While the UNAIDS 95- 95- 95 targets
have been met among adults, those for children and
adolescents remain suboptimal. This study aimed to
improve the return- to- care rates among children and
adolescents living with HIV (CALHIV) who missed clinic
appointments at a county- level rural health facility in
eastern Uganda.
Methods Between January 2023 and January 2024, we
conducted a continuous quality improvement (CQI) study.
A CQI committee was established through entry meetings
and training, and quality of care gaps were identified
through data reviews. We prioritised one gap for CQI
through ranking, performed a root- cause analysis using a
f
ishbone diagram, and developed and ranked improvement
changes using the impact- effort matrix. The improvement
changes were implemented using Plan- Do- Study- Act
cycles. The changes included (1) line listing CALHIV with
missed appointments and following up via phone calls; (2)
weekly data reviews to harmonise missed appointments
and (3) assigning community health workers (CHWs) to
trace and return CALHIV to care. We tracked and plotted
the proportion of CALHIV returning to care over time to
assess improvements.
Results Before the implementation of CQI initiatives
(August 2022–January 2023), the average return- to- care
rate was 35% (baseline). Following the initiation of CQI in
February 2023, the average return- to- care rate increased
to 59% from February to May 2023 with the introduction
of line listing (phase 1), to 69% from June to September
2023 with the implementation of weekly data reviews
(phase 2), and to 88% from October 2023 to January
2024 with the involvement of CHWs (phase 3), ultimately
reaching a peak of 100% in January 2024.
Conclusion The CQI approach improved the return to
care of CALHIV who missed clinic appointments, allowing
access to optimal care and better health outcomes.
These findings should serve as preliminary data for larger
randomised studies.The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not- for- profit sectors
Return to care of children and adolescents living with HIV who missed their clinic visits or were lost to follow-up: a continuous quality improvement study in Uganda
No full textBackground While the UNAIDS 95-95-95 targets have been met among adults, those for children and adolescents remain suboptimal. This study aimed to improve the return-to-care rates among children and adolescents living with HIV (CALHIV) who missed clinic appointments at a county-level rural health facility in eastern Uganda.Methods Between January 2023 and January 2024, we conducted a continuous quality improvement (CQI) study. A CQI committee was established through entry meetings and training, and quality of care gaps were identified through data reviews. We prioritised one gap for CQI through ranking, performed a root-cause analysis using a fishbone diagram, and developed and ranked improvement changes using the impact-effort matrix. The improvement changes were implemented using Plan-Do-Study-Act cycles. The changes included (1) line listing CALHIV with missed appointments and following up via phone calls; (2) weekly data reviews to harmonise missed appointments and (3) assigning community health workers (CHWs) to trace and return CALHIV to care. We tracked and plotted the proportion of CALHIV returning to care over time to assess improvements.Results Before the implementation of CQI initiatives (August 2022–January 2023), the average return-to-care rate was 35% (baseline). Following the initiation of CQI in February 2023, the average return-to-care rate increased to 59% from February to May 2023 with the introduction of line listing (phase 1), to 69% from June to September 2023 with the implementation of weekly data reviews (phase 2), and to 88% from October 2023 to January 2024 with the involvement of CHWs (phase 3), ultimately reaching a peak of 100% in January 2024.Conclusion The CQI approach improved the return to care of CALHIV who missed clinic appointments, allowing access to optimal care and better health outcomes. These findings should serve as preliminary data for larger randomised studies
Treatment success rate and associated factors among drug susceptible tuberculosis individuals in St. Kizito Hospital, Matany, Napak district, Karamoja region. A retrospective study.
No full textBackgroundTuberculosis (TB) is the leading cause of death among infectious agents globally. An estimated 10 million people are newly diagnosed and 1.5 million die of the disease annually. Uganda is among the 30 high TB-burdenedd countries, with Karamoja having a significant contribution of the disease incidence in the country. Control of the disease in Karamoja is complex because a majority of the at-risk population remain mobile; partly because of the nomadic lifestyle. This study, therefore, aimed at describing the factors associated with drug-susceptible TB treatment success rate (TSR) in the Karamoja region.MethodsThis was a retrospective study on case notes of all individuals diagnosed with and treated for drug-susceptible TB at St. Kizito Hospital Matany, Napak district, Karamoja from 1st Jan 2020 to 31st December 2021. Data were abstracted using a customised data abstraction tool. Data analyses were done using Stata statistical software, version 15.0. Chi-square test was conducted to compare treatment success rates between years 2020 and 2021, while Modified Poisson regression analysis was performed at multivariable level to determine the factors associated with treatment success.ResultsWe studied records of 1234 participants whose median age was 31 (IQR: 13-49) years. Children below 15 years of age accounted for 26.2% (n = 323). The overall treatment success rate for the study period was 79.3%(95%CI; 77.0%-81.5%), with a statistically significant variation in 2020 and 2021, 75.4% (422/560) vs 82.4% (557/674) respectively, (P = 0.002). The commonest reported treatment outcome was treatment completion at 52%(n = 647) and death was at 10.4% (n = 129). Older age, undernutrition (Red MUAC), and HIV-positive status were significantly associated with lower treatment success: aPR = 0.87(95%CI; 0.80-0.94), aPR = 0.91 (95%CI; 0.85-0.98) and aPR = 0.88 (95%CI; 0.78-0.98); respectively. Patients who were enrolled in 2021 had a high prevalence of treatment success compared to those enrolled in 2020, aPR = 1.09 (95%CI; 1.03-1.16).ConclusionTB TSR in Matany Hospital was suboptimal. Older age, poor nutrition, and being HIV-positive were negative predictors of treatment success. We propose integrating nutrition and HIV care into TB programming to improve treatment success
A retrospective study
No full textBackground Tuberculosis (TB) is the leading cause of death among infectious agents globally. An estimated 10million people are newly diagnosed and 1.5 million die of the disease annually. Uganda is among the 30highTB-burdened countries, with Karamoja having a significant contribution of the disease incidence in the country. Control of the disease in Karamoja is complex because a majority of the at-risk population remains mobile; partly because of the nomadic lifestyle. This study, therefore, aimed at describing the factors associated with drug-susceptible TB treatment success rate (TSR) in the Karamoja region.
Methods
This was a retrospective study on case notes of all individuals diagnosed with and treated for drug-susceptible TB at St. Kizito Hospital Matany, Napak district, Karamoja from 1 2020 to 31 st st Jan December 2021. Data were abstracted using a customized data abstraction tool. Data analyses were done using Stata statistical software, version 15.0. A chi-square test was conducted to compare treatment success rates between the years 2020 and 2021, while Modified Poisson regression analysis was performed at a multivariable level to determine the factors associated with treatment success.
Results
We studied records of 1234 participants whose median age was 31(IQR: 13–49) years. Children below 15 years of age accounted for 26.2% (n = 323). The overall treatment success rate for the study period was 79.3%(95%CI; 77.0%-81.5%), with a statistically significant variation in 2020 and 2021, 75.4% (422/560) vs 82.4% (557/674) respectively, (P = 0.002). The commonest reported treatment outcome was treatment completion at 52 %(n = 647) and death at wasat10.4%(n=129). Older age, undernutrition (Red MUAC), and HIV-positive status were significantly associated with lower treatment success: aPR = 0.87(95% CI; 0.80–0.94), aPR = 0.91 (95%CI; 0.85–0.98) and aPR = 0.88 (95%CI; 0.78–0.98); respectively. Patients who were enrolled in 2021 had a high prevalence of treatment success compared to those enrolled in 2020, aPR = 1.09 (95%CI; 1.03–1.16).
Conclusion
TBTSR in Matany Hospital was suboptimal. Older age, poor nutrition, and being HIV-positive were negative predictors of treatment success. We propose integrating nutrition and HIV care into TB programming to improve treatment successFunding: This publication was partially (data
collection) supported through SUNRIF, Soroti
University research and innovation fund, Round1,
Award No SUNRIF2022/22 to Ronald Opito. The
views and opinions of the authors expressed herein
do not necessarily state or reflect those of the
funder. There was no additional external funding
received for this study
IPT completion rate ratio estimates comparing DSD models.
No full textIPT completion rate ratio estimates comparing DSD models.</p
Number and proportion of participants who completed IPT across DSD models.
No full textNumber and proportion of participants who completed IPT across DSD models.</p
Characteristics of participants by DSD models.
No full textBackgroundTuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective way of delivering ART. DSD models include Community Drug Distribution Point (CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management (FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is known about the impact of delivering IPT through DSD.MethodsWe reviewed medical records of PLHIV who initiated IPT between June-September 2019 at TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH). We defined IPT completion as completing a course of isoniazid within 6–9 months. We utilized a modified Poisson regression to compare IPT completion across DSD models and determine factors associated with IPT completion in each DSD model.ResultsData from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females: 60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen: 61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile range [IQR]; 32.3–50.2) and 6.0 (IQR: 3.7–8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8–93.7%); highest in CDDP (98.1%, 95%CI: 95.0–99.3%) and lowest in FBG (85.8%, 95%CI: 79.0–90.7%). Compared to FBIM, IPT completion was significantly higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09–1.22) and CCLAD (aRR = 1.09, 95% CI 1.02–1.16). In facility-based models, IPT completion differed between sites (pConclusionIPT completion was high overall but highest in community-based models. Our findings provide evidence that supports integration of IPT within DSD models for ART delivery in Uganda and similar settings.</div
An implementation guide for DSD models of HIV and TB services in Uganda.
No full textAn implementation guide for DSD models of HIV and TB services in Uganda.</p
Inclusivity in global research.
No full textBackgroundTuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective way of delivering ART. DSD models include Community Drug Distribution Point (CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management (FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is known about the impact of delivering IPT through DSD.MethodsWe reviewed medical records of PLHIV who initiated IPT between June-September 2019 at TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH). We defined IPT completion as completing a course of isoniazid within 6–9 months. We utilized a modified Poisson regression to compare IPT completion across DSD models and determine factors associated with IPT completion in each DSD model.ResultsData from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females: 60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen: 61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile range [IQR]; 32.3–50.2) and 6.0 (IQR: 3.7–8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8–93.7%); highest in CDDP (98.1%, 95%CI: 95.0–99.3%) and lowest in FBG (85.8%, 95%CI: 79.0–90.7%). Compared to FBIM, IPT completion was significantly higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09–1.22) and CCLAD (aRR = 1.09, 95% CI 1.02–1.16). In facility-based models, IPT completion differed between sites (pConclusionIPT completion was high overall but highest in community-based models. Our findings provide evidence that supports integration of IPT within DSD models for ART delivery in Uganda and similar settings.</div
