9 research outputs found
Therapeutic Drug Monitoring of Anti-infective Drugs:Implementation Strategies for 3 Different Scenarios
Get PDFBACKGROUND: Therapeutic drug monitoring (TDM) supports personalized treatment. For successful implementation, TDM must have a turnaround time suited to the clinical needs of patients and their health care settings. Here, the authors share their views of how a TDM strategy can be tailored to specific settings and patient groups.METHODS: The authors selected distinct scenarios for TDM: high-risk, complex, and/or critically ill patient population; outpatients; and settings with limited laboratory resources. In addition to the TDM scenario approach, they explored potential issues with the legal framework governing dose escalation.RESULTS: The most important issues identified in the different scenarios are that critically ill patients require rapid turnaround time, outpatients require an easy sampling procedure for the sample matrix and sample collection times, settings with limited laboratory resources necessitate setting-specific analytic techniques, and all scenarios warrant a legal framework to capture the use of escalated dosages, ideally with the use of trackable dosing software.CONCLUSIONS: To benefit patients, TDM strategies need to be tailored to the intended population. Strategies can be adapted for rapid turnaround time for critically ill patients, convenient sampling for outpatients, and feasibility for those in settings with limited laboratory resources.</p
Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania
Get PDFThis research article was published by John Wiley & Sons, Inc., 2022Objective
Diabetes mellitus (DM) has been known to compromise tuberculosis (TB) treatment outcomes. Association data are limited for early hyperglycaemia detection and TB treatment outcomes. Thus, we assessed treatment outcomes including time to sputum conversion and death in TB participants with or without hyperglycaemia.
Methods
A prospective cohort study recruited TB participants receiving anti-TB treatment at health facilities in Tanzania between October 2019 and September 2020. Hyperglycaemia was defined as having pre-existing DM or pre-treatment random blood glucose of ≥7.8mmol/L, in combination categorised as impaired glucose regulation (IGR). Those with IGR were further screened for hyperglycaemia severity using glycated haemoglobin. In case of unknown status, participants were tested for HIV. Time to death was determined at 6 months of TB treatment.
Results
Of 1,344 participants, 187 (13.9%) had IGR, of whom 44 (23.5%) were HIV co-infected. Overall treatment success was 1,206 (89.7%), and was similar among participants with or without IGR (p>0.05). Time to death for participants with and without IGR was 18 versus 28 days (p=0.870), respectively. Age ≥40 years (p=0.038), bacteriological positive (p=0.039), HIV (p=0.009), or recurrent TB (p=0.017) predicted death or treatment success during TB treatment in adjusted multivariable models.
Conclusion
IGR did not influence clinical outcomes in TB patients with or without IGR in a programme of early IGR diagnosis and integration TB, HIV and DM care. Early detection and co-management of multi-morbidities among people diagnosed with TB may reduce likelihood of poor treatment outcomes in a programmatic setting
Transforming Nursing Practice to Optimize Care of Patients with Tuberculosis and Associated Comorbidities in the Kilimanjaro Region, Tanzania
No full textBackground: Managing tuberculosis (TB) patients with comorbidities requires a holistic and patient-centered approach. This study evaluated patient-centered care (PCC) experiences among TB patients with multimorbidity under the Adaptive Diseases Control Expert Program in Tanzania (ADEPT), with a focus on the TB/diabetes mellitus (DM) co-epidemic targeted by the program. Methods: A quantitative cross-sectional study was conducted involving TB patients with associated comorbidities receiving care from nurses trained in PCC through the ADEPT program. Patients were assessed for their interpretation of how they received PCC across eight dimensions of care. Results: All 39 participants with TB had at least one comorbidity (100%). The most common multi-morbidities were TB/HIV (59.0%) and TB/DM (12.8%). Evaluation of needs, values, and preferences revealed that participants strongly felt healthcare workers considered these aspects (mean score = 4.53; scale 1 minimum- strongly disagree to 5 maximum- strongly agree). Subsequent analysis showed varying evaluations across dimensions. Patients reported robust endorsement for receiving care that involved family and friends, with mean scores of 4.04, and for access to care, with a mean score of 4.40. However, physical comfort, coordination, continuity of care, education and emotional support received comparatively lower rankings. Conclusion: TB patients with multimorbidity under the ADEPT program experienced PCC. However, certain systemic issues such as physical spaces, coordination, transition of care, and information education did not meet patient’s needs in their own assessment, indicating opportunities for further quality improvement. Scaling up the ADEPT program within healthcare systems is likely to enhance care provision for TB patients with multimorbidity through a patient-centered approach.</p
Clinical Audit for Integration of Communicable and Non-Communicable Diseases at the Primary Health Care Level in Tanzania
No full textINTRODUCTION: Poor quality of health care services remains an important challenge in health care delivery systems. Here, we validate clinical audit tools and describe audit results of selected clinical standards related to communicable disease (CD) and non-communicable disease (NCD) integration at the primary health care level.METHODOLOGY: A multi-methods approach, including a retrospective cohort and cross-sectional design, was deployed concurrently at Health Centres. Separate evaluators assessed the Health Centres using an audit tool and the inter-rater/inter-observer reliability was estimated. The extent of adherence to clinical standards was measured in proportions for: infection prevention control, tuberculosis (TB) diagnosis including advanced TB/Human Immunodeficiency Virus (HIV), the diagnosis of chronic lung diseases, and the bidirectional screening and clinical management of TB and Diabetes Mellitus (DM).RESULTS: The inter-rater reliability for the clinical audit tools based on 130 individuals' charts was 99.5% (CI:99-100). The total estimated maximum score for infection prevention control was 114 and on average health centres scored 42 (37%). Only 3 (4%) of 80 individuals' medical charts with unexplained productive cough were evaluated for TB. None of the 24 individuals with HIV infection medical charts had vitals measured and only 6 (25%) patients with advanced HIV had a TB test performed, whereas 4 (17%) had a cryptococcal antigen test, and 1 (4%) had a chest radiograph. Also, 24 patients' chart from documented HIV negative with chronic cough had no records of spirometry or peak flowmeter or a chest radiograph. However, a diagnosis of asthma and chronic obstructive pulmonary disease as made in 17 (71%) and 7 (29%), respectively. TB was confirmed for 102 patients among whom only 12(12%) were screened for DM. The DM clinics had no TB presumptive registers. Patients with TB/DM (n=2) had a glycated haemoglobin (HbA1c) measurement done and received appropriate management.CONCLUSION AND RECOMMENDATION: The developed clinical audit tools were reliable and could contribute to quality measurement for metrics-related integration of CD and NCD in Tanzania. Further investigations will determine if the clinical audit tools widely used in cycles can improve the quality of care in health care delivery systems.</p
Experiences and perceptions of participants on the pathway towards clinical management of dual tuberculosis and diabetes mellitus in Tanzania
No full textBACKGROUND: Diabetes mellitus (DM) is a common comorbidity among people with tuberculosis (TB). Despite the availability of guidelines on how to integrate dual TB/DM in Tanzania, the practice of integration at various healthcare levels is unclear. OBJECTIVE: To explore the participants’ experiences and perceptions on the pathway towards clinical management of dual TB/DM. METHOD: The research was carried out in Dar es Salaam, Iringa, and Kilimanjaro regions between January and February 2020. A qualitative, in-depth interview approach was used to collect participants’ experiences and perspectives on the acquisition of dual TB/DM services at various levels of healthcare facilities. The information gathered were coded and classified thematically. RESULTS: The participants’ perception of TB services within the healthcare facilities was positive due to the support they received from the healthcare providers. On the other hand, participants reported difficulty receiving management in various health facilities for each condition in terms of access to dual TB/DM care and access to DM medication. This was viewed as a significant challenge for the participants with dual TB/DM. CONCLUSIONS: The current disjunction and disruption in healthcare for people with dual TB/DM makes it difficult to access services at various levels of health facilities. For optimal clinical management for people with dual TB/DM, patient-centered strategies and integrated approaches are urgently needed
Point-of-care glycated hemoglobin a1c testing for the identification of hyperglycemia severity among individuals with dual tuberculosis and diabetes mellitus in Tanzania
No full textBACKGROUND: Poor glycemic control during tuberculosis (TB) treatment is challenging, as the optimum treatment strategy remains unclear. We assessed hyperglycemia severity using glycated hemoglobin (HbA1c) test and predictors of severe hyperglycemia at the time of TB diagnosis in three resources-diverse regions in Tanzania.METHODS: This was a substudy from a large cohort study implemented in three regions of Tanzania. TB individuals with diabetes mellitus (DM) (prior history of DM or newly diagnosed DM) were assessed for hyperglycemic levels using HbA1c test and stratified as mild (<53 mmol/mol), moderate (≥53-<86 mmol/mol), and severe (≥86 mmo/mol).RESULTS: From October 2019 to September 2020, 1344 confirmed TB individuals were screened for DM and 105 (7.8%) individuals had dual TB/DM and were assessed for glycemic levels. Of these, 69 (67.7%) had a prior history of DM and 26 (24.8%) were living with human immunodeficiency virus. Their mean age was 49.0 (±15.0) years and 56.2% were male. The majority (77.1%) had pulmonary TB, and 96.2% were newly diagnosed TB individuals. HbA1c test identified 41(39.0%), 37 (35.2%), and 27 (25.7%) individuals with severe, moderate, and mild the hyperglycaemia respectively. Female sex (odds ratio [OR]: 3.55, 95% confidence interval [CI]: 1.06-11.92, P = 0.040) and previous history of DM (OR: 3.71, 95% CI: 1.33-10.33, P = 0.013) were independent risk factors for severe hyperglycemic at the time of TB diagnosis.CONCLUSION: By integrating early HbA1c testing, a substantial proportion of individuals with severe hyperglycemia were identified. HbA1c testing can be recommended to identify and triage patients requiring personalized intensified DM management in resource-limited programmatic settings.</p
Where can Tanzania health system integrate clinical management of patients with dual tuberculosis and diabetes mellitus?:A cross-sectional survey at varying levels of health facilities
No full textObjective: To assess the current Tanzania health facilities readiness in integrating clinical management of dual Tuberculosis (TB) and Diabetes Mellitus (DM) by using the Service Availability and Readiness Assessment (SARA) manual of the World Health Organization prior to implementing an integrated service model. Study design: Cross-sectional study. Methods: A needs assessment survey was conducted at varying levels of health care facilities. The SARA manual evaluated the service delivery outcomes in terms of availability of guidelines, medicines and diagnostic equipment, training of healthcare workers in providing TB and DM care, and patient record review. Data were analyzed using Statistical Package for Social Science version 26. Results: Among 29 health facilities selected, three were regional referral hospitals, eight were district hospitals and eighteen were health centers. Baseline investigations revealed that GeneXpert MTB/RIF machines were present in 10 (34.5%) facilities, and glycated hemoglobin devices were present in two (6.9%) facilities, while all health facilities had a glucometer. The presence of an attending medical doctor in 19 (65.5%) facilities and the presence of operating biochemistry analyzers in 15 (51.7%) facilities were two mandatory variables used to assess readiness. Among the various guidelines observed, none of the facilities had the 2016 DM guidelines. Overall, 15 (51.7%) health facilities were ready to integrate dual TB and DM services. Conclusion: Integrative TB/DM screening and management activities can be achieved only if integration initiatives are prioritized at all levels of health facilities and among health policy makers in Tanzania. At least half of the health facilities were prepared to integrate the management of dual TB/DM. However, there is an urgent need to mobilize significant resources to improve the integration in these facilities, such as management guidelines and diagnostics.</p
Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania
No full text Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods: This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs' reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results: From 2019-2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6-19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0-3) ( p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35-75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions: It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services. </p
Abstracts of Tanzania Health Summit 2020
Get PDFThis book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future.
Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS)
