Suchergebnisse

Operational research is necessary to improve the access to and delivery of tuberculosis prevention, diagnosis and treatment interventions for people living with HIV. We conducted an extensive review of the literature and reports from recent expert consultations and research‐related meetings organized by the World Health Organization and the Stop TB Partnership to identify a TB/HIV operational research agenda. We present critical operational research questions in a series of key areas: optimizing TB prevention by enhancing the uptake of isoniazid preventive therapy and the implementation of infection control measures; assessing the effectiveness of existing diagnostic tools and scaling up new technologies; improving service delivery models; and reducing risk factors for mortality among TB patients living with HIV. We discuss the potential impact that addressing the operational research questions may have on improving programmes' performance, assessing new strategies or interventions for TB control, or informing global or national policy formulation. Financial resources to implement these operational research questions should be mobilized from existing and new funding mechanisms. National TB and HIV/AIDS programmes should develop their operational research agendas based on these questions, and conduct the research that they consider crucial for improving TB and HIV control in their settings in collaboration with research stakeholders.

Abstract Background Following health sector reform, Ethiopia started training new categories of health workers. This study addresses students' perspectives regarding their training and career plans. Methods A cross sectional questionnaire was administered to 145 students in the three schools of the Amhara regional state of Ethiopia. Results The majority of students were male (62%) and originally from urban areas (76%). Job search was the most common reason for enrolling in the training for almost half (48%) of the respondents, followed by a desire to help the sick (46%). Once trained, the majority (98%) of graduates preferred to serve in the government sector and in rural health institutions (84%). Females were more willing to work in rural settings [χ 2 (df 1)= 7.37; P = 0.007]. The majority (98%) of students felt the training period should be extended. 12% of graduates lacked confidence in their competencies after completing the training. A substantial proportion of the respondents (29%) did not feel the social science courses ( Anthropology, Ecology and Psychology ) were useful. Conclusions This study demonstrates that mid-level health professional students are highly motivated, wish to address the health needs of rural communities, and are interested in professional development. However, students do not feel the training programs are fully addressing their needs. The students found that the duration of the training, the time for theory and practice, the availability of teaching materials, the course contents and their teachers were inadequate. This study suggests that the current training programs have serious inadequacies that need to be addressed.

HIV associated TB is a major public health problem. In 2006, it was estimated that there were over 700,000 people who suffered from HIV associated TB, of whom about 200, 000 have died. The burden of HIV associated TB is greatest in Sub‐Saharan Africa where the TB epidemic is primarily driven by HIV. There has been steady progress made in reducing the burden of HIV in TB patients with an increasing number of TB patients tested for HIV and provided with cotrimoxazole preventive therapy (CPT) and anti‐retroviral treatment (ART). Less progress is being made to reduce the burden of TB in people living with HIV. The number of HIV infected persons reported to have been screened for TB was less than 1% while Isoniazid preventive therapy was reported to have been provided to less than 0.1% of eligible persons in 2006. A major push is urgently needed to accelerate the implementation of three important interventions. The three are Intensified TB Screening (ICF) among people living with HIV, the provision of Isoniazid Preventive Therapy (IPT) and TB Infection Control(IC). These interventions are best carried out by HIV control programmes which should therefore be encouraged to take greater responsibility in implementing these interventions.

IntroductionEvery year, HIV‐associated tuberculosis (TB) deprives 350,000 mainly young people of productive and healthy lives. People die because TB is not diagnosed and treated in those with known HIV infection and HIV infection is not diagnosed in those with TB. Even in those in whom both HIV and TB are diagnosed and treated, this often happens far too late. These deficiencies can be addressed through the application of new scientific evidence and diagnostic tools.DiscussionA strategy of starting antiretroviral therapy (ART) early in the course of HIV infection has the potential to considerably reduce both individual and community burden of TB and needs urgent evaluation for efficacy, feasibility and broader social and economic impact. Isoniazid preventive therapy can reduce the risk of TB and, if given strategically in addition to ART, provides synergistic benefit. Intensified TB screening as part of the "Three I's" strategy should be conducted at every clinic, home or community‐based attendance using a symptoms‐based algorithm, and new diagnostic tools should increasingly be used to confirm or refute TB diagnoses. Until such time when more sensitive and specific TB diagnostic assays are widely available, bolder approaches such as empirical anti‐TB treatment need to be considered and evaluated. Patients with suspected or diagnosed TB must be screened for HIV and given cotrimoxazole preventive therapy and ART if HIV‐positive. Three large randomized trials provide conclusive evidence that ART initiated within two to four weeks of start of anti‐TB treatment saves lives, particularly in those with severe immunosuppression. The key to ensuring that these collaborative activities are delivered is the co‐location and integration of TB and HIV services within the health system and the community.ConclusionsProgress towards reducing HIV‐associated TB deaths can be achieved through attention to simple and deliverable actions on the ground.John Donne, Meditation XVII, Devotions upon Emergent Occasions:… any mans death diminishes me because I am involved in Mankinde; And therefore never send to know for whom the bell tolls; it tolls for thee ….

IntroductionDespite significant progress in improving access to antiretroviral therapy over the past decade, substantial numbers of people living with HIV (PLHIV) in all regions continue to experience severe illness and require hospitalization. We undertook a global review assessing the proportion of hospitalizations and in‐hospital deaths because of tuberculosis (TB) in PLHIV.MethodsSeven databases were searched to identify studies reporting causes of hospitalizations among PLHIV from 1 January 2007 to 31 January 2015 irrespective of age, geographical region or language. The proportion of hospitalizations and in‐hospital mortality attributable to TB was estimated using random effects meta‐analysis.ResultsFrom an initial screen of 9049 records, 66 studies were identified, providing data on 35,845 adults and 2792 children across 42 countries. Overall, 17.7% (95% CI 16.0 to 20.2%) of all adult hospitalizations were because of TB, making it the leading cause of hospitalization overall; the proportion of adult hospitalizations because of TB exceeded 10% in all regions except the European region. Of all paediatric hospitalizations, 10.8% (95% CI 7.6 to 13.9%) were because of TB. There was insufficient data among children for analysis by region. In‐hospital mortality attributable to TB was 24.9% (95% CI 19.0 to 30.8%) among adults and 30.1% (95% CI 11.2 to 48.9%) among children.DiscussionTB remains a leading cause of hospitalization and in‐hospital death among adults and children living with HIV worldwide.

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions. ; SCOPUS: re.j ; info:eu-repo/semantics/published