Journal Article > ResearchFull Text
Oxford Medical Journal. 6 November 2024; Online ahead of print; DOI:10.1093/inthealth/ihae066
Harrison RE, Shyleika V, Vishneuski R, Leonovich O, Vetushko D, et al.
Oxford Medical Journal. 6 November 2024; Online ahead of print; DOI:10.1093/inthealth/ihae066
BACKGROUND
TB is concentrated in populations with complex health and social issues, including alcohol use disorders (AUD). We describe treatment adherence and outcomes in a person-centred, multidisciplinary, psychosocial support and harm reduction intervention for people with multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) with harmful alcohol use.
METHODS
An observational cohort study, including multilevel mixed-effects logistic regression and survival analysis with people living in Minsk admitted with MDR/RR-TB and AUD during January 2019–November 2021 who received this person-centred, multidisciplinary, psychosocial support and harm reduction intervention, was conducted.
RESULTS
There were 89 participants enrolled in the intervention, with a median follow-up of 12.2 (IQR: 8.1–20.5) mo. The majority (n=80; 89.9%) of participants had AUD, 11 (12.4%) also had a dependence on other substances, six (6.7%) a dependence on opioids and three (3.4%) a personality disorder. Fifty-eight had a history of past incarceration (65.2%), homelessness (n=9; 10.1%) or unemployment (n=55; 61.8%). Median adherence was 95.4% (IQR: 90.4–99.6%) and outpatient adherence was 91.2% (IQR: 65.1–97.0%). Lower adherence was associated with hepatitis C, alcohol plus other substance use and outpatient facility-based treatment, rather than video-observed treatment, home-based or inpatient treatment support.
CONCLUSIONS
This intervention led to good adherence to MDR/RR-TB treatment in people with harmful use of alcohol, a group usually at risk of poor outcomes. Poor outcomes were associated with hepatitis C, other substance misuse and outpatient facility-based treatment support.
Journal Article > ResearchFull Text
PLOS One. 13 March 2023; Volume 18 (Issue 3); e0281425.; DOI:10.1371/journal.pone.0281425
Albus SL, Harrison RE, Moudachirou R, Nanan-N’Zeth K, Haba B, et al.
PLOS One. 13 March 2023; Volume 18 (Issue 3); e0281425.; DOI:10.1371/journal.pone.0281425
INTRODUCTION
Optimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge.
METHODS
We carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes.
RESULTS
401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28–45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm,166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge.
CONCLUSION
Outcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care.
Optimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge.
METHODS
We carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes.
RESULTS
401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28–45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm,166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge.
CONCLUSION
Outcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care.
Journal Article > ResearchFull Text
Lancet Global Health. 1 February 2023; Volume 11 (Issue 2); e296-e300.; DOI:10.1016/S2214-109X(22)00479-X
Abouyannis M, Esmail H, Hamaluba M, Ngama M, Mwangudzah H, et al.
Lancet Global Health. 1 February 2023; Volume 11 (Issue 2); e296-e300.; DOI:10.1016/S2214-109X(22)00479-X
Snakebite clinical trials have often used heterogeneous outcome measures and there is an urgent need for standardisation. A globally representative group of key stakeholders came together to reach consensus on a globally relevant set of core outcome measurements. Outcome domains and outcome measurement instruments were identified through searching the literature and a systematic review of snakebite clinical trials. Outcome domains were shortlisted by use of a questionnaire and consensus was reached among stakeholders and the patient group through facilitated discussions and voting. Five universal core outcome measures should be included in all future snakebite clinical trials-mortality, WHO disability assessment scale, patient-specific functional scale, acute allergic reaction by Brown criteria, and serum sickness by formal criteria. Additional syndrome-specific core outcome measures should be used depending on the biting species. This core outcome measurement set provides global standardisation, supports the priorities of patients and clinicians, enables meta-analysis, and is appropriate for use in low-income and middle-income settings.
Journal Article > ResearchFull Text
Med Trop Sante Int
MTSI
MTSI bulletin
MTSI magazine
MTSI-Revue
Médecine tropicale et santé internationale. Bulletin
Médecine tropicale et santé internationale. Magazine
MTSI, la revue de la Société francophone de médecine tropicale et santé internationale. 1 February 2023; Volume 3 (Issue 3); DOI:10.48327/mtsi.v3i3.2023.421
Abouyannis M, Esmail H, Hamaluba M, Ngama M, Mwangudzah H, et al.
Med Trop Sante Int
MTSI
MTSI bulletin
MTSI magazine
MTSI-Revue
Médecine tropicale et santé internationale. Bulletin
Médecine tropicale et santé internationale. Magazine
MTSI, la revue de la Société francophone de médecine tropicale et santé internationale. 1 February 2023; Volume 3 (Issue 3); DOI:10.48327/mtsi.v3i3.2023.421
English
Français
CONTEXTE
Les essais cliniques sur les morsures de serpent ont souvent utilisé des critères de décision hétérogènes qui demandent à être standardisés.
MÉTHODE
Un groupe d'acteurs clés mondialement représentatifs s'est réuni pour parvenir à un consensus sur un jeu universel de critères de décision de base. Les domaines d'intérêt et les instruments d'évaluation des critères de décision ont été identifiés à partir d'une recherche documentaire et d'un examen systématique des essais cliniques concernant les envenimations par morsure de serpent. Les domaines d'intérêt ont été présélectionnés à l'aide d'un questionnaire et un consensus a été obtenu entre le groupe d'acteurs et un groupe représentatif de patients à la suite de discussions orientées et d'un vote.
RÉSULTATS
Cinq critères de décision de base universels devraient être inclus dans tous les futurs essais cliniques sur les morsures de serpent : la mortalité, l'échelle d'évaluation du handicap de l'OMS, l'échelle fonctionnelle propre à chaque patient, la réaction allergique immédiate selon les critères de Brown et la maladie sérique en fonction de critères formels. D'autres critères de décision spécifiques aux différents syndromes observés lors des envenimations par morsure de serpent doivent être utilisés en fonction de l'espèce responsable de la morsure.
CONCLUSION
Ce jeu universel de critères de décision de base permet une standardisation mondiale, répond aux priorités des patients et des cliniciens, favorise des méta-analyses et est compatible avec une utilisation dans les pays à revenu faible ou intermédiaire.
Les essais cliniques sur les morsures de serpent ont souvent utilisé des critères de décision hétérogènes qui demandent à être standardisés.
MÉTHODE
Un groupe d'acteurs clés mondialement représentatifs s'est réuni pour parvenir à un consensus sur un jeu universel de critères de décision de base. Les domaines d'intérêt et les instruments d'évaluation des critères de décision ont été identifiés à partir d'une recherche documentaire et d'un examen systématique des essais cliniques concernant les envenimations par morsure de serpent. Les domaines d'intérêt ont été présélectionnés à l'aide d'un questionnaire et un consensus a été obtenu entre le groupe d'acteurs et un groupe représentatif de patients à la suite de discussions orientées et d'un vote.
RÉSULTATS
Cinq critères de décision de base universels devraient être inclus dans tous les futurs essais cliniques sur les morsures de serpent : la mortalité, l'échelle d'évaluation du handicap de l'OMS, l'échelle fonctionnelle propre à chaque patient, la réaction allergique immédiate selon les critères de Brown et la maladie sérique en fonction de critères formels. D'autres critères de décision spécifiques aux différents syndromes observés lors des envenimations par morsure de serpent doivent être utilisés en fonction de l'espèce responsable de la morsure.
CONCLUSION
Ce jeu universel de critères de décision de base permet une standardisation mondiale, répond aux priorités des patients et des cliniciens, favorise des méta-analyses et est compatible avec une utilisation dans les pays à revenu faible ou intermédiaire.
Journal Article > ResearchFull Text
Public Health Action. 21 June 2022; Volume 12 (Issue 2); 58-63.; DOI:10.5588/pha.21.0051
Mbau L, Harrison RE, Kizito W, Timire C, Namusonge T, et al.
Public Health Action. 21 June 2022; Volume 12 (Issue 2); 58-63.; DOI:10.5588/pha.21.0051
BACKGROUND
Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya.
DESIGN
This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included.
RESULTS
Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control.
CONCLUSIONS
The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.
Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya.
DESIGN
This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included.
RESULTS
Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control.
CONCLUSIONS
The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.
Journal Article > ResearchFull Text
BMC Public Health. 3 February 2021; Volume 21 (Issue 1); DOI:10.1186/s12889-021-10327-5
Sumbi EM, Venables E, Harrison RE, Garcia MG, Iakovidi K, et al.
BMC Public Health. 3 February 2021; Volume 21 (Issue 1); DOI:10.1186/s12889-021-10327-5
Background: It is estimated that 64,000 children under 15 years of age are living with HIV in the Democratic Republic of Congo (DRC). Non-disclosure - in which the child is not informed about their HIV status - is likely to be associated with poor outcomes during adolescence including increased risk of poor adherence and retention, and treatment failure. Disclosing a child's HIV status to them can be a difficult process for care-givers and children, and in this qualitative study we explored child and care-giver experiences of the process of disclosing, including reasons for delay.
Methods: A total of 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children whom they were caring for were conducted in one health-care facility in the capital city of Kinshasa. Care-givers were purposively sampled to include those who had disclosed to their children and those who had not. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Interviews were conducted in French and Lingala. All interviews were translated and/or transcribed into French before being manually coded. Thematic analysis was conducted. Verbal informed consent/assent was taken from all interviewees.
Results: At the time of interview, the mean age of children and care-givers was 17 (15-19) and 47 (21-70) years old, respectively. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them.
Conclusions: Child disclosure is a complex process for care-givers, health-care workers and the children themselves. Care-givers may require additional psycho-social support to manage disclosure. Involving multiple care-givers in the care of HIV positive children could offer additional support for disclosure.
Methods: A total of 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children whom they were caring for were conducted in one health-care facility in the capital city of Kinshasa. Care-givers were purposively sampled to include those who had disclosed to their children and those who had not. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Interviews were conducted in French and Lingala. All interviews were translated and/or transcribed into French before being manually coded. Thematic analysis was conducted. Verbal informed consent/assent was taken from all interviewees.
Results: At the time of interview, the mean age of children and care-givers was 17 (15-19) and 47 (21-70) years old, respectively. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them.
Conclusions: Child disclosure is a complex process for care-givers, health-care workers and the children themselves. Care-givers may require additional psycho-social support to manage disclosure. Involving multiple care-givers in the care of HIV positive children could offer additional support for disclosure.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 8 March 2021; Volume 15 (Issue 3); e0009169.; DOI:10.1371/journal.pntd.0009169
Chika Igwenyi N, Harrison RE, Psarra C, Gil Cuesta J, Gulamhusein M, et al.
PLoS Negl Trop Dis. 8 March 2021; Volume 15 (Issue 3); e0009169.; DOI:10.1371/journal.pntd.0009169
Lassa fever (LF) is an acute viral haemorrhagic illness with various non-specific clinical manifestations. Neurological symptoms are rare at the early stage of the disease, but may be seen in late stages, in severely ill patients.The aim of this study was to describe the epidemiological evolution, socio-demographic profiles, clinical characteristics, and outcomes of patients seen during two Lassa fever outbreaks in Ebonyi State, between December 2017 and December 2018. Routinely collected clinical data from all patients admitted to the Virology Centre of the hospital during the period were analysed retrospectively. Out of a total of 83 cases, 70(84.3%) were RT-PCR confirmed while 13 (15.7%) were probable cases. Sixty-nine (83.1%) patients were seen in outbreak 1 of whom 53.6% were urban residents, while 19%, 15%, and 10% were farmers, students and health workers respectively. There were 14 (16.8%) patients, seen in second outbreak with 92.9% rural residents. There were differences in clinical symptoms, signs and laboratory findings between the two outbreaks. The case fatality rates were 29.9% in outbreak 1 and 85.7% for outbreak 2. Neurological features and abnormal laboratory test results were associated with higher mortality rate, seen in outbreak 2. This study revealed significant differences between the two outbreaks. Of particular concern was the higher case fatality during the outbreak 2 which may be from a more virulent strain of the Lassa virus. This has important public health implications and further molecular studies are needed to better define its characteristics.
Journal Article > ResearchFull Text
Clin Infect Dis. 4 March 2018; Volume 66 (Issue suppl_2); DOI:10.1093/cid/ciy103
Ousley J, Niyibizi AA, Wanjala S, Vandenbulcke A, Kirubi B, et al.
Clin Infect Dis. 4 March 2018; Volume 66 (Issue suppl_2); DOI:10.1093/cid/ciy103
Human immunodeficiency virus (HIV) remains an important cause of hospitalization and death in low- and middle- income countries. Yet morbidity and in-hospital mortality patterns remain poorly characterized, with prior antiretroviral therapy (ART) exposure and treatment failure status largely unknown.
Journal Article > ResearchFull Text
BMC Infect Dis. 7 October 2020; Volume 20 (Issue 1); 734.; DOI:10.1186/s12879-020-05470-0
Mangana F, Massaquoi L, Moudachirou R, Harrison RE, Kaluangila T, et al.
BMC Infect Dis. 7 October 2020; Volume 20 (Issue 1); 734.; DOI:10.1186/s12879-020-05470-0
BACKGROUND
HIV continues to be the main determinant morbidity with high mortality rates in Sub-Saharan Africa, with a high number of patients being late presenters with advanced HIV. Clinical management of advanced HIV patients is thus complex and requires strict adherence to updated, empirical and simplified guidelines. The current study investigated the impact of the implementation of a new clinical guideline on the management of advanced HIV in Kinshasa, Democratic Republic of Congo (DRC).
METHODS
A retrospective analysis of routine clinical data of advanced HIV patients was conducted for the periods; February 2016 to March 2017, before implementation of new guidelines, and November 2017 to July 2018, after the implementation of new guidelines. Eligible patients were patients with CD4 < 200 cell/µl and presenting with at least 1 of 4 opportunistic infections. Patient files were reviewed by a medical doctor and a committee of 3 other doctors for congruence. Statistical significance was set at 0.05%.
RESULTS
Two hundred four and Two hundred thirty-one patients were eligible for inclusion before and after the implementation of new guidelines respectively. Sex and age distributions were similar for both periods, and median CD4 were 36 & 52 cell/µl, before and after the new guidelines implementation, respectively. 40.7% of patients had at least 1 missed/incorrect diagnosis before the new guidelines compared to 30% after new guidelines, p < 0.05. Clinical diagnosis for TB and toxoplasmosis were also much improved after the implementation of new guidelines. In addition, only 63% of patients had CD4 count test results before the new guidelines compared to 99% of patients after new guidelines. Death odds after the implementation of new guidelines were significantly lower than before new guidelines in a multivariate regression model that included patients CD4 count and 10 other covariates, p < 0.05.
CONCLUSIONS
Simplification and implementation of a new and improved HIV clinical guideline coupled with the installation of laboratory equipment and point of care tests potentially helped reduce incorrect diagnosis and improve clinical outcomes of patients with advanced HIV. Regulating authorities should consider developing simplified versions of guidelines followed by the provision of basic diagnostic equipment to health centers.
HIV continues to be the main determinant morbidity with high mortality rates in Sub-Saharan Africa, with a high number of patients being late presenters with advanced HIV. Clinical management of advanced HIV patients is thus complex and requires strict adherence to updated, empirical and simplified guidelines. The current study investigated the impact of the implementation of a new clinical guideline on the management of advanced HIV in Kinshasa, Democratic Republic of Congo (DRC).
METHODS
A retrospective analysis of routine clinical data of advanced HIV patients was conducted for the periods; February 2016 to March 2017, before implementation of new guidelines, and November 2017 to July 2018, after the implementation of new guidelines. Eligible patients were patients with CD4 < 200 cell/µl and presenting with at least 1 of 4 opportunistic infections. Patient files were reviewed by a medical doctor and a committee of 3 other doctors for congruence. Statistical significance was set at 0.05%.
RESULTS
Two hundred four and Two hundred thirty-one patients were eligible for inclusion before and after the implementation of new guidelines respectively. Sex and age distributions were similar for both periods, and median CD4 were 36 & 52 cell/µl, before and after the new guidelines implementation, respectively. 40.7% of patients had at least 1 missed/incorrect diagnosis before the new guidelines compared to 30% after new guidelines, p < 0.05. Clinical diagnosis for TB and toxoplasmosis were also much improved after the implementation of new guidelines. In addition, only 63% of patients had CD4 count test results before the new guidelines compared to 99% of patients after new guidelines. Death odds after the implementation of new guidelines were significantly lower than before new guidelines in a multivariate regression model that included patients CD4 count and 10 other covariates, p < 0.05.
CONCLUSIONS
Simplification and implementation of a new and improved HIV clinical guideline coupled with the installation of laboratory equipment and point of care tests potentially helped reduce incorrect diagnosis and improve clinical outcomes of patients with advanced HIV. Regulating authorities should consider developing simplified versions of guidelines followed by the provision of basic diagnostic equipment to health centers.
Journal Article > ResearchFull Text
BMC Public Health. 3 February 2021; Volume 21; DOI:10.1186/s12889-021-10327-5
Sumbi EM, Venables E, Harrison RE, Garcia MG, Iakovidi K, et al.
BMC Public Health. 3 February 2021; Volume 21; DOI:10.1186/s12889-021-10327-5
La crise liée au Covid-19 a fragilisé les populations en situation préalable de précarité. L’émergence de l’insécurité alimentaire et de logement a poussé les acteurs de la santé, du travail social et les autorités à mettre en place des mesures innovantes et intersectorielles permettant de répondre rapidement et efficacement aux besoins essentiels de ces populations. Cet article présente trois de ces mesures, à savoir une équipe mobile interprofessionnelle de dépistage, un dispositif d’hébergement et d’encadrement sanitaire pour les personnes sans-abri et un programme de distribution alimentaire à large échelle. Ces trois exemples illustrent la nécessité d’une approche transversale et collaborative et le besoin d’agir sur les déterminants sociaux et politiques sous-tendant ces vulnérabilités.
The COVID-19 crisis has rapidly increased the vulnerability of groups of population already facing precarious living conditions. The emergence of food and housing insecurity have forced health and social actors along with the local authorities to implement innovative responses in order to respond to these unmet needs. This article presents some of these responses, such as an interdisciplinary mobile COVID-19 screening team, an emergency housing program and a large-scale food assistance program. These examples highlight the need for an intersectoral, coordinated and collaborative response simultaneously targeting different domains of insecurity in parallel to actions on the underpinning social and political determinants of these vulnerabilities.
The COVID-19 crisis has rapidly increased the vulnerability of groups of population already facing precarious living conditions. The emergence of food and housing insecurity have forced health and social actors along with the local authorities to implement innovative responses in order to respond to these unmet needs. This article presents some of these responses, such as an interdisciplinary mobile COVID-19 screening team, an emergency housing program and a large-scale food assistance program. These examples highlight the need for an intersectoral, coordinated and collaborative response simultaneously targeting different domains of insecurity in parallel to actions on the underpinning social and political determinants of these vulnerabilities.