Suchergebnisse

Background Poverty is a barrier to health equity. While it is believed that tuberculosis (TB) and Human Immunodeficiency Virus (HIV) care is free in Kenya, this is only partially true. Co-morbidities such as diabetes mellitus (DM), which are not currently subsidized, triple the risk of contracting TB and contribute to poor outcomes such as drug-resistant TB (DR-TB), while also increasing the cost of care. After TB treatment, there is a three-fold risk of death, with cardiovascular disease being a major contributor, and diabetes is directly correlated with cardiovascular risk. The lack of costing data on co-morbidities in TB/HIV care has made it challenging to define a subsidized care package for patients. Methods This cross-sectional, mixed methods, nested design study aimed to determine the cost of managing TB patients, with or without HIV, in addition to diabetes or prediabetes, from a health system perspective using a bottom-up (BU) approach. The study aimed to propose a minimum care package as part of efforts towards universal health coverage in Kenya. STATA was used to randomly sample 36 health facilities within Nairobi County, Kenya, representing 10 of the 17 sub-counties. Results The average health system costs for screening, diagnosis, and risk counseling of TB patients were USD ($) 27.26 in public and USD ($) 44.70 in private health facilities, averaging USD ($) 35.98. The costs for managing TB and HIV, TB and DM, and TB, DM, and HIV in public and private facilities respectively were USD ($) 28.17 and USD ($) 51.75, USD ($) 31.75 and USD ($) 47.93, and USD ($) 32.67 and USD ($) 54.98. Conclusions The cost of managing dysglycemia in TB and HIV patients is incremental, and subsidies can improve access to care. The proposed minimum care package, which includes dysglycemia care (self-monitoring, cardiovascular and ophthalmology screening, and foot care), is almost ten times less than what the health system currently pays for TB complications like DR-TB.

BACKGROUND. Using classical and genomic epidemiology, we tracked the COVID-19 pandemic in Kenya over 23 months to determine the impact of SARS-CoV-2 variants on its progression. METHODS. SARS-CoV-2 surveillance and testing data were obtained from the Kenya Ministry of Health, collected daily from 306 health facilities. COVID-19-associated fatality data were also obtained from these health facilities and communities. Whole SARS-CoV-2 genome sequencing were carried out on 1241 specimens. RESULTS. Over the pandemic duration (March 2020 - January 2022) Kenya experienced five waves characterized by attack rates (AR) of between 65.4 and 137.6 per 100,000 persons, and intra-wave case fatality ratios (CFR) averaging 3.5%, two-fold higher than the national average COVID-19 associated CFR. The first two waves that occurred before emergence of global variants of concerns (VoC) had lower AR (65.4 and 118.2 per 100,000). Waves 3, 4, and 5 that occurred during the second year were each dominated by multiple introductions each, of Alpha (74.9% genomes), Delta (98.7%), and Omicron (87.8%) VoCs, respectively. During this phase, government-imposed restrictions failed to alleviate pandemic progression, resulting in higher attack rates spread across the country. CONCLUSIONS. The emergence of Alpha, Delta, and Omicron variants was a turning point that resulted in widespread and higher SARS-CoV-2 infections across the country.