Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014-2016.

Autor:	Ng'ambi W; International Training and Education Center for Health (I-TECH), Lilongwe, Malawi.; Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi., Gugsa S; Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.; I-TECH, Seattle, Washington, USA., Tweya H; Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.; International Union Against Tuberculosis and Lung Disease, Paris, France., Girma B; International Training and Education Center for Health (I-TECH), Lilongwe, Malawi.; National Tuberculosis Control Programme, Lilongwe, Malawi., Kanyerere H; National Tuberculosis Control Programme, Lilongwe, Malawi., Dambe I; National Tuberculosis Control Programme, Lilongwe, Malawi., Babaye Y; International Training and Education Center for Health (I-TECH), Lilongwe, Malawi., Mpunga J; National Tuberculosis Control Programme, Lilongwe, Malawi., Phiri S; Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.; Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi.
Jazyk:	angličtina
Zdroj:	Public health action [Public Health Action] 2017 Dec 21; Vol. 7 (4), pp. 282-288. Date of Electronic Publication: 2017 Nov 20.
DOI:	10.5588/pha.17.0050
Abstrakt:	Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert ® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities. Competing Interests: Conflicts of interest: none declared.
Databáze:	MEDLINE
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