Journal Article > CommentaryFull Text
Public Health Action. 21 September 2012; Volume 2 (Issue 3); DOI:10.5588/pha.12.0022
Bissell K, Harries AD, Reid A, Edginton ME, Hinderaker SG, et al.
Public Health Action. 21 September 2012; Volume 2 (Issue 3); DOI:10.5588/pha.12.0022
Journal Article > LetterFull Text
Trop Med Int Health. 30 May 2013; Volume 18 (Issue 8); DOI:10.1111/tmi.12133
Zachariah R, Reid AJ, Van der Bergh R, Dahmane A, Kosgei RJ, et al.
Trop Med Int Health. 30 May 2013; Volume 18 (Issue 8); DOI:10.1111/tmi.12133
Journal Article > CommentaryFull Text
Public Health Action. 21 September 2013; Volume 3 (Issue 3); DOI:10.5588/pha.13.0066
Harries AD, Kumar AMV, Satyanarayana S, Bissell K, Hinderaker SG, et al.
Public Health Action. 21 September 2013; Volume 3 (Issue 3); DOI:10.5588/pha.13.0066
Journal Article > CommentaryFull Text
Public Health Action. 21 June 2013; Volume 3 (Issue 2); DOI:10.5588/pha.13.0002
Mlilo N, Sandy C, Harries AD, Kumar AMV, Masuka N, et al.
Public Health Action. 21 June 2013; Volume 3 (Issue 2); DOI:10.5588/pha.13.0002
Journal Article > LetterFull Text
Int J Tuberc Lung Dis. 1 June 2012; Volume 16 (Issue 8); 1129-1130.; DOI:10.5588/ijtld.12.0370-2
Zachariah R, Edginton ME, Srinath S
Int J Tuberc Lung Dis. 1 June 2012; Volume 16 (Issue 8); 1129-1130.; DOI:10.5588/ijtld.12.0370-2
Journal Article > ResearchFull Text
PLOS One. 10 November 2015; Volume 10 (Issue 11); e0142873.; DOI:10.1371/journal.pone.0142873
Daniels J, Khogali MA, Mohr E, Cox V, Moyo S, et al.
PLOS One. 10 November 2015; Volume 10 (Issue 11); e0142873.; DOI:10.1371/journal.pone.0142873
SETTING
Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection.
OBJECTIVE
To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes.
DESIGN
A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation.
RESULTS
Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm3. Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4).
CONCLUSIONS
Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.
Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection.
OBJECTIVE
To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes.
DESIGN
A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation.
RESULTS
Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm3. Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4).
CONCLUSIONS
Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.
Journal Article > ResearchFull Text
Public Health Nutr. 6 August 2015; Volume 19 (Issue 7); 1296-304..; DOI:10.1017/S1368980015002207
Nsabuwera V, Hedt-Gauthier BL, Khogali MA, Edginton ME, Hinderaker SG, et al.
Public Health Nutr. 6 August 2015; Volume 19 (Issue 7); 1296-304..; DOI:10.1017/S1368980015002207
OBJECTIVE
Determining interventions to address food insecurity and poverty, as well as setting targets to be achieved in a specific time period have been a persistent challenge for development practitioners and decision makers. The present study aimed to assess the changes in food access and consumption at the household level after one-year implementation of an integrated food security intervention in three rural districts of Rwanda.
DESIGN
A before-and-after intervention study comparing Household Food Insecurity Access Scale (HFIAS) scores and household Food Consumption Scores (FCS) at baseline and after one year of programme implementation.
SETTING
Three rural districts of Rwanda (Kayonza, Kirehe and Burera) where the Partners In Health Food Security and Livelihoods Program (FSLP) has been implemented since July 2013.
SUBJECTS
All 600 households enrolled in the FSLP were included in the study.
RESULTS
There were significant improvements (P<0·001) in HFIAS and FCS. The median decrease in HFIAS was 8 units (interquartile range (IQR) -13·0, -3·0) and the median increase for FCS was 4·5 units (IQR -6·0, 18·0). Severe food insecurity decreased from 78% to 49%, while acceptable food consumption improved from 48% to 64%. The change in HFIAS was significantly higher (P=0·019) for the poorest households.
CONCLUSIONS
Our study demonstrated that an integrated programme, implemented in a setting of extreme poverty, was associated with considerable improvements towards household food security. Other government and non-government organizations' projects should consider a similar holistic approach when designing structural interventions to address food insecurity and extreme poverty.
Determining interventions to address food insecurity and poverty, as well as setting targets to be achieved in a specific time period have been a persistent challenge for development practitioners and decision makers. The present study aimed to assess the changes in food access and consumption at the household level after one-year implementation of an integrated food security intervention in three rural districts of Rwanda.
DESIGN
A before-and-after intervention study comparing Household Food Insecurity Access Scale (HFIAS) scores and household Food Consumption Scores (FCS) at baseline and after one year of programme implementation.
SETTING
Three rural districts of Rwanda (Kayonza, Kirehe and Burera) where the Partners In Health Food Security and Livelihoods Program (FSLP) has been implemented since July 2013.
SUBJECTS
All 600 households enrolled in the FSLP were included in the study.
RESULTS
There were significant improvements (P<0·001) in HFIAS and FCS. The median decrease in HFIAS was 8 units (interquartile range (IQR) -13·0, -3·0) and the median increase for FCS was 4·5 units (IQR -6·0, 18·0). Severe food insecurity decreased from 78% to 49%, while acceptable food consumption improved from 48% to 64%. The change in HFIAS was significantly higher (P=0·019) for the poorest households.
CONCLUSIONS
Our study demonstrated that an integrated programme, implemented in a setting of extreme poverty, was associated with considerable improvements towards household food security. Other government and non-government organizations' projects should consider a similar holistic approach when designing structural interventions to address food insecurity and extreme poverty.
Journal Article > CommentaryFull Text
Int J Tuberc Lung Dis. 16 June 2012 (Issue 6)
Zachariah R, Harries AD, Srinath S, Ram S, Viney K, et al.
Int J Tuberc Lung Dis. 16 June 2012 (Issue 6)
The words 'defaulter', 'suspect' and 'control' have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side-that of the patients. In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words 'defaulter', 'suspect' and 'control' and argue why it is detrimental to continue using them in the context of TB. We propose that 'defaulter' be replaced with 'person lost to follow-up'; that 'TB suspect' be replaced by 'person with presumptive TB' or 'person to be evaluated for TB'; and that the term 'control' be replaced with 'prevention and care' or simply deleted. These terms are non-judgmental and patient-centred. We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.
Journal Article > Short ReportFull Text
Public Health Action. 21 March 2012; Volume 2 (Issue 1); DOI:10.5588/pha.12.0001
Edginton ME, Enarson D, Zachariah R, Reid AJ, Satyanarayana S, et al.
Public Health Action. 21 March 2012; Volume 2 (Issue 1); DOI:10.5588/pha.12.0001
Journal Article > CommentaryFull Text
Public Health Action. 21 September 2013; Volume 3 (Issue 3); 253-4.; DOI:10.5588/pha.13.0029
Oladimeji O, Isaakidis P, Zachariah R, Hinderaker SG, Koghali M, et al.
Public Health Action. 21 September 2013; Volume 3 (Issue 3); 253-4.; DOI:10.5588/pha.13.0029
Ethics approval of research studies is essential for the protection and rights of study subjects, whether this is for prospective research or record reviews. This article shares a painful lesson learned from a field experience where the appropriate steps for obtaining ethics approval were not followed by a young researcher. This researcher had embarked on an operational research project, but had omitted to seek ethics approval from a local ethics committee. Young researchers, particularly from low- and middle-income countries, need to learn about the importance and value of ethics.