22 research outputs found
Designing an optimized diagnostic network to improve access to TB diagnosis and treatment in Lesotho.
No full textBACKGROUND:To reach WHO End tuberculosis (TB) targets, countries need a quality-assured laboratory network equipped with rapid diagnostics for tuberculosis diagnosis and drug susceptibility testing. Diagnostic network analysis aims to inform instrument placement, sample referral, staffing, geographical prioritization, integration of testing enabling targeted investments and programming to meet priority needs. METHODS:Supply chain modelling and optimization software was used to map Lesotho's TB diagnostic network using available data sources, including laboratory and programme reports and health and demographic surveys. Various scenarios were analysed, including current network configuration and inclusion of additional GeneXpert and/or point of care instruments. Different levels of estimated demand for testing services were modelled (current [30,000 tests/year], intermediate [41,000 tests/year] and total demand needed to find all TB cases [88,000 tests/year]). RESULTS:Lesotho's GeneXpert capacity is largely well-located but under-utilized (19/24 sites use under 50% capacity). The network has sufficient capacity to meet current and near-future demand and 70% of estimated total demand. Relocation of 13 existing instruments would deliver equivalent access to services, maintain turnaround time and reduce costs compared with planned procurement of 7 more instruments. Gaps exist in linking people with positive symptom screens to testing; closing this gap would require extra 11,000 tests per year and result in 1000 additional TB patients being treated. Closing the gap in linking diagnosed patients to treatment would result in a further 629 patients being treated. Scale up of capacity to meet total demand will be best achieved using a point-of-care platform in addition to the existing GeneXpert footprint. CONCLUSIONS:Analysis of TB diagnostic networks highlighted key gaps and opportunities to optimize services. Network mapping and optimization should be considered an integral part of strategic planning. By building efficient and patient-centred diagnostic networks, countries will be better equipped to meet End TB targets
Antituberculosis Drug Resistance Survey in Lesotho, 2008-2009: Lessons Learned.
No full textDrug resistance is an increasing threat to tuberculosis (TB) control worldwide. The World Health Organization advises monitoring for drug resistance, with either ongoing surveillance or periodic surveys.The antituberculosis drug resistance survey was conducted in Lesotho in 2008-2009. Basic demographic and TB history information was collected from individuals with positive sputum smear results at 17 diagnostic facilities. Additional sputum sample was sent to the national TB reference laboratory for culture and drug susceptibility testing.Among 3441 eligible smear-positive persons, 1121 (32.6%) were not requested to submit sputum for culture. Among 2320 persons submitted sputum, 1164 (50.2%) were not asked for clinical information or did not have valid sputum samples for testing. In addition, 445/2320 (19.2%) were excluded from analysis because of other laboratory or data management reasons. Among 984/3441 (28.6%) persons who had data available for analysis, MDR-TB was present in 24/773 (3.1%) of new and 25/195 (12.8%) of retreatment TB cases. Logistical, operational and data management challenges affected survey results.MDR-TB is prevalent in Lesotho, but limitations reduced the reliability of our findings. Multiple lessons learned during this survey can be applied to improve the next drug resistance survey in Lesotho and other resource constrained countries may learn how to avoid these bottlenecks
First and second-line drug susceptibility test results for MDR-TB isolates, Lesotho, 2008–2009 (N = 39).
No full text<p>*Missing results—previously treated with missing amikacin = 1; capreomycin = 1; cycloserine = 1; ethionamide = 1; ofloxacin = 1; para-amino salicylic acid = 1; pyrazinamide = 1</p><p>MDR-TB—multidrug-resistant tuberculosis.</p><p>First and second-line drug susceptibility test results for MDR-TB isolates, Lesotho, 2008–2009 (N = 39).</p
Map of Lesotho.
No full text<p>Image source: <a href="https://www.cia.gov/library/publications/the-world-factbook/index.html" target="_blank">https://www.cia.gov/library/publications/the-world-factbook/index.html</a>.</p
First-line drug susceptibility test results, Lesotho, 2008–2009 (N = 984).
No full text<p><sup>†</sup>Missing results—new patients with missing isoniazid result = 13</p><p><sup>§</sup>Missing results—previously treated patients with missing isoniazid result = 3</p><p>First-line drug susceptibility test results, Lesotho, 2008–2009 (N = 984).</p
Lesotho Drug Resistance Survey (DRS) Sampling Flow Diagram.
No full text<p>Lesotho Drug Resistance Survey (DRS) Sampling Flow Diagram.</p
Penundaan Pembagian Waris: Suatu Tinjauan Teoretis dalam Kerangka Sistem Hukum di Indonesia
No full textDelays in the distribution of inheritance are common in the Banjar community, and these delays in the distribution of inheritance cause various problems, ranging from conflicts between heirs that cause family relationships to break down, neglected inheritance, to litigation between families in court. This paper intends to scrutinize why this delay in inheritance distribution occurs. To answer this, the author discusses it in the perspective of Laurence M. Friedman's Legal System Theory, this research uses qualitative research methods in the form of empirical legal research. Data were obtained through in-depth interviews and observations, then analyzed with interpretative descriptive analysis. From this research, it was found that the legal structure of delaying the distribution of inheritance, namely religious courts, judges, advocates and scholars do not have the authority to "force" the community to immediately distribute inheritance. The substance of the law, namely the Qur'an, al-Hadis, Fiqh books and the Compilation of Islamic Law as the source of inheritance law of the Banjar community does not explicitly state the time of distribution of inheritance, even this source of law they "abandon", customary inheritance law is the law that lives and becomes the legal culture of the community regarding the time of inheritance implementation, where for generations they have delayed the distribution of inheritance, distributing inheritance immediately is considered an unethical or uncivilized act.Penundaan pembagian waris banyak terjadi pada masyarakat Banjar, penundaan pembagian waris ini menimbulkan berbagai persoalan, mulai dari konflik antar ahli waris yang menyebabkan retaknya hubungan keluarga, harta warisan yang terlantar hingga gugat menggugat antar sesama keluarga di pengadilan. Tulisan ini bermaksud mengkritisi lebih dalam mengapa penundaan pembagian waris tersebut terjadi. Untuk menjawab hal tersebut penulis membahasnya dalam perspektif Teori Legal System Laurence M. Friedman, penelitian ini menggunakan metode penelitian kualitatif dalam bentuk penelitian hukum empiris. Data didapatkan melalui wawancara mendalam dan observasi, kemudian dianalilsis dengan analisis deskriptif interpretatif. Dari penelitian ini ditemukan bahwa Struktur hukum penundaan pembagianwaris, yaitu pengadilan agama, hakim, advokat dan ulama tidak memiliki kewenangan untuk “memaksa” masyarakat untuk sesegeranya membagikan waris. Substansi hukum yaitu Al-Qur’an, al-Hadis, kitab-kitab Fiqh dan Kompilasi Hukum Islam sebagai sumber hukum waris masyarakat Banjar tidak eksplisit menyatakan waktu pembagian waris, bahkan sumber hukum ini mereka “tinggalkan”, hukum waris adatlah hukum yang hidup dan menjadi budaya hukum masyarakat terkait waktu pelaksanaan waris, di mana secara turun temurun mareka melakukan penundaan pembagian waris, membagikan waris dengan segera dinilai sebagai perbuatan tidak etis atau tidak beradat
Head-to-head comparison of nasal and nasopharyngeal sampling using SARS-CoV-2 rapid antigen testing in Lesotho
No full textOBJECTIVES: To assess the real-world diagnostic performance of nasal and nasopharyngeal swabs for SD Biosensor STANDARD Q COVID-19 Antigen Rapid Diagnostic Test (Ag-RDT). METHODS: Individuals >/=5 years with COVID-19 compatible symptoms or history of exposure to SARS-CoV-2 presenting at hospitals in Lesotho received two nasopharyngeal and one nasal swab. Ag-RDT from nasal and nasopharyngeal swabs were performed as point-of-care on site, the second nasopharyngeal swab used for polymerase chain reaction (PCR) as the reference standard. RESULTS: Out of 2198 participants enrolled, 2131 had a valid PCR result (61% female, median age 41 years, 8% children), 84.5% were symptomatic. Overall PCR positivity rate was 5.8%. The sensitivity for nasopharyngeal, nasal, and combined nasal and nasopharyngeal Ag-RDT result was 70.2% (95%CI: 61.3-78.0), 67.3% (57.3-76.3) and 74.4% (65.5-82.0), respectively. The respective specificity was 97.9% (97.1-98.4), 97.9% (97.2-98.5) and 97.5% (96.7-98.2). For both sampling modalities, sensitivity was higher in participants with symptom duration </= 3days versus /= 80%. The high agreement between nasal and nasopharyngeal sampling suggests that for Ag-RDT nasal sampling is a good alternative to nasopharyngeal sampling
Sensitivity and Specificity of Ag-RDT on nasopharyngeal and nasal samples as compared to nasopharyngeal PCR in different subgroups.
No full textSensitivity and Specificity of Ag-RDT on nasopharyngeal and nasal samples as compared to nasopharyngeal PCR in different subgroups.</p
Participants’ baseline characteristics.
No full textThe surge of the COVID-19 pandemic challenged health services globally, and in Lesotho, the HIV and tuberculosis (TB) services were similarly affected. Integrated, multi-disease diagnostic services were proposed solutions to mitigate these disruptions. We describe and evaluate the effect of an integrated, hospital-based COVID-19, TB and HIV screening and diagnostic model in two rural districts in Lesotho, during the period between December 2020 and August 2022. Adults, hospital staff, and children above 5 years attending two hospitals were pre-screened for COVID-19 and TB symptoms. After a positive pre-screening, participants were offered to enroll in a service model that included clinical evaluation, chest radiography, SARS-CoV-2, TB, and HIV testing. Participants diagnosed with COVID-19, TB, or HIV were contacted after 28 days to evaluate their health status and linkage to HIV and/or TB care services. Of the 179160 participants pre-screened, 6623(3.7%) pre-screened positive, and 4371(66%) were enrolled in this service model. Of the total 458 diagnoses, only 17 happened in children. One positive rapid antigen test for SARS-CoV-2 was found per 11 participants enrolled, one Xpert-positive TB case was diagnosed per 85 people enrolled, and 1 new HIV diagnosis was done per 182 people enrolled. Of the 321(82.9%) participants contacted after 28 days of diagnosis, 304(94.7%) reported to be healthy. Of the individuals that were newly diagnosed with HIV or TB, 18/24(75.0%) and 46/51(90.1%) started treatment within 28 days of the diagnosis. This screening and diagnostic model successfully maintained same-day, integrated COVID-19, TB, and HIV testing services, despite frequent disruptions caused by the surge of COVID-19 waves, healthcare seeking patterns, and the volatile context (social measures, travel restrictions, population lockdowns). There were positive effects in avoiding diagnostic delays and ensuring linkage to services, however, diagnostic yields for adults and children were low. To inform future preparedness plans, research will need to identify essential health interventions and how to optimize them along each phase of the emergency response.</div
