Public Health Action最新文献

Setting: The study was conducted across three health facilities in Sierra Leone, Princess Christian Maternity Hospital (tertiary), Rokupa Government Hospital (secondary), and George Brook Community Health Centre (primary).

Objectives: To assess retention rates and identify factors associated with continued engagement of pregnant women living with HIV (PWLHIV) in antenatal and postnatal care.

Methods: A retrospective cohort study using 2024 routinely collected antenatal and elimination of mother-to-child transmission (eMTCT) data. Retention during antenatal and postnatal care was retrospectively assessed. Data were analysed, applying Poisson regression models to estimate relative risks.

Results: Of 397 PWLHIV enrolled, 84 (21.1%) were retained in antenatal care and 79 (25.9%) in postnatal care. Higher antenatal retention was linked to being newly diagnosed with HIV (adjusted relative risk [aRR] = 7.67), having no formal education (aRR = 2.99), and older age. These factors also predicted postnatal retention, with adjusted relative risks of 14.30 for newly diagnosed women, 1.34 for older women, and 2.96 for those with no formal education.

Conclusion: Retention of pregnant and postpartum women living with HIV is low. Newly diagnosed, older, and less-educated women have better retention, while younger and already aware women struggle with engagement. We recommend enhanced counselling and targeted re-engagement strategies.

Setting: Since 2017, India's TB programme is implementing active case finding (ACF) in high-risk populations in all districts. Symptom screening followed by confirmatory testing was the ACF algorithm.

Objective: To determine differences in pre-treatment delays and severe illness at diagnosis between ACF- and passive case finding (PCF)-detected adults with drug-sensitive pulmonary TB in high-risk populations.

Design: Cross-sectional analytical study from 28 randomly sampled districts across India (2023). Post-triaging, severe illness was defined as presence of very severe undernutrition, respiratory insufficiency, or poor performance status.

Results: Of 790 enrolled, 426 were ACF-detected and 364 PCF-detected. ACF-detected adults were significantly older (mean 47.1 year vs 43.9 year), lived farther from diagnosis facilities (median 8 km vs 6 km), had lower formal education exposure (52% vs 37% with no formal education), lower household income (₹20,000 vs ₹24,000 annual per capita), and experienced fewer health care provider visits (median 1 vs 2). Pre-treatment delay from symptom onset to treatment initiation (median 46 days in both groups) and burden of severe illness (39% vs 34%, P = 0.180) were similar.

Conclusion: Though ACF linked the vulnerable to care and reduced health care provider visits, this did not translate into early detection. High burden of severe illness at diagnosis is a concern.

This issue of Public Health Action (PHA) includes the first of a series of articles that provide evidence-based answers to questions raised by health workers on addressing HIV, TB and malaria on the frontlines in Sierra Leone. The research was conducted as part of a SORT IT course, which is a partnership-based initiative led by TDR and implemented with various partners. SORT IT aims to make countries 'data rich, information rich and action rich' to improve health care delivery and outcomes. The course in Sierra Leone brought together 19 institutions to foster global engagement, partnerships and communities of practice, and highlighted the convening power of SORT IT towards galvanizing research capacity strengthening at the country level.

Background: The majority of active TB cases in low-burden, high-income settings arise from reactivation of TB infection (TBI). The London Borough of Newham, UK, piloted a novel screening and treatment TBI programme for recent migrants. This was situated entirely within primary care.

Objective and design: This study aims to highlight key enablers and barriers to delivering a TBI programme in primary care. Views of health care professionals and relevant stakeholders were sought through questionnaires and semi-structured interviews.

Results: Perspectives from 43 health care professionals are included. A perceived 'good relationship' between patients and health care professionals was the most commonly cited enablers across groups, followed by education and training of service providers. Physicians reported time constraints as a common barrier, whereas pharmacists were more likely to identify low levels of patient knowledge surrounding TBI as a barrier to engagement. Enablers identified by stakeholders included effective communication between stakeholders and training of service providers. Aggregate data collection and monitoring was considered a significant enabler, as was patient education by health care professionals and novel educational tools.

Conclusion: Community-based TBI programmes can be successful. Key enablers include TBI-specific training with communities and amongst health care professionals, collaboration between health care professionals and stakeholders, and aggregate data monitoring.

Antimicrobial resistance (AMR) threatens global health and requires sustained, integrated responses beyond short-term initiatives. EU-JAMRAI 2 mobilises over 120 partners to produce scalable solutions aligned with One Health priorities. To ensure long-term uptake, the French Ministry of Health developed a Sustainability Guidance Tool (SGT) supporting work packages in defining priority outcomes, anticipating risks, and embedding results into national systems. This dynamic approach, based on iterative revision and alignment with National Action Plans (NAPs), strengthens governance, financing, monitoring, and policy integration. By summarising early lessons from design and implementation, this article informs future transnational AMR policy planning and sustainability strategies.

Setting: Ola During Children's Hospital, a tertiary-level paediatric facility affiliated with a university and located in Freetown, Sierra Leone. No published studies from Sierra Leone have evaluated treatment outcomes in children (<15 years) with drug-sensitive TB (DS-TB).

Objective: To assess compliance with national TB treatment guidelines and evaluate treatment outcomes among children with DS-TB.

Design: A non-concurrent cohort study, utilising routinely collected secondary patient data from TB treatment master cards. Poisson regression was done to calculate adjusted relative risks (aRR).

Results: Of 689 children, 95% received treatment regimens compliant with national guidelines. However, only 32% achieved favourable outcomes, while 68% had unfavourable outcomes (7% death, 30% loss to follow-up, 31% not evaluated). HIV co-infection (aRR = 1.2) and HIV-unknown status (aRR = 1.5), residence outside urban areas (aRR = 1.3), and extra-pulmonary TB (aRR = 1.2) were significantly associated with unfavourable outcomes. Children treated in 2023 (aRR = 0.7) and 2024 (aRR = 0.6) had better outcomes than those in 2022.

Conclusion: Despite high compliance with treatment protocols, paediatric TB outcomes were alarmingly unfavourable. Strengthening follow-up systems and data recording, integrating TB-HIV services, and decentralising care are critical to improving outcomes in this vulnerable population.

Setting: Sierra Leone has a high burden of drug-resistant TB (DR-TB), managed at three treatment centres.

Objective: To compare treatment success between BPaL (bedaquiline, pretomanid, and linezolid)/BPaLM (bedaquiline, pretomanid, linezolid, and moxifloxacin) and the standardised short and the individualised long regimens among DR-TB patients and identify predictors of unsuccessful outcomes.

Design: Retrospective cohort study utilising routinely collected national DR-TB data from January 2022 to December 2024.

Results: Among 598 DR-TB patients registered from 2022 to 2024, 571 with complete outcomes were analysed. Overall treatment success was 80.2%, highest with BPaL/BPaLM (87.1%) compared with the standardised short (78.8%) and individualised long regimens (70.4%). Adjusted analyses showed BPaL/BPaLM remained strongly associated with higher success than the individualised long (adjusted risk ratio [aRR] 2.89; 95% confidence interval [CI] 1.80-4.64) and standardised short regimens (aRR 1.46; 95% CI 1.04-2.05). HIV co-infection and underweight body mass index independently predicted poor outcomes. Findings were consistent across propensity-weighted and sensitivity analyses.

Conclusion: Under routine programmatic conditions in Sierra Leone, BPaL/BPaLM achieved higher treatment success than standardised short or individualised long regimens. However, HIV co-infection and undernutrition predicted poorer outcomes, underscoring the need for integrated nutritional support, expanded drug-susceptibility testing, and strengthened TB/HIV services.

Background: Kenya, a high-TB-burden country, is among eight WHO-priority countries for public-private mix (PPM) initiatives to engage all health care providers in TB prevention and care.

Objective: To describe Kenya's experience implementing a Global Fund-supported PPM intervention and its contribution to TB case finding.

Design: A descriptive case study using programmatic data from a Global Fund-supported PPM project implemented in nine counties in Kenya.

Results: Of 2,027 mapped facilities, 1,405 signed Memoranda of Understanding and 1,269 reported TB services. Of 4.3 million people screened, 260,922 (6%) were identified as presumptive TB, of whom 108,723 (42%) were investigated. Overall, 14,026 individuals were diagnosed with TB (64% bacteriologically confirmed), and 99% initiated on treatment. Level II facilities contributed 45% of notifications (7 per facility), while Level V facilities (only 4) reported the highest average yield (130 per facility). All counties recorded increased TB notifications during implementation, followed by a decline in Quarter 3, 2024.

Conclusion: Engaging private sector providers significantly enhanced TB case detection. Kenya's PPM experience highlights the engagement choices that need to be made among levels of the health care system for scaling and sustaining PPM models in resource-constrained settings.

Setting: In 2013, the New York City Health Department analysed its TB contact tracing programme. Despite long-term declines, TB remained a persistent public health issue in New York City, necessitating continued investment in prevention strategies.

Objectives: The aim was to evaluate the financial and public health impact of the TB contact tracing programme by conducting a return-on-investment (ROI) analysis.

Design: The study measured programme costs - including personnel, diagnostics, and follow-up care - against projected savings from averted TB cases. A sensitivity analysis was conducted to assess the impact of varying progression rates from TB infection (TBI) to active TB.

Results: The programme identified 3,250 contacts and prevented 64 potential TB cases through early detection and TBI treatment. This resulted in a 95.13% ROI, meaning that for every dollar invested, nearly another dollar was saved. The ROI increased under assumptions of higher TBI progression rates, reinforcing the programme's cost-effectiveness.

Conclusion: Contact tracing plays a critical role in TB control, especially in urban areas with higher incidence. The evaluation supports sustained investment in public health infrastructure and demonstrates that the model can be applied to other infectious disease programmes for targeted prevention and early intervention.

Background: Adherence to antiretroviral therapy (ART) is crucial for the clinical management of people living with HIV (PLHIV), but food insecurity can compromise it. The threshold at which food insecurity significantly affects adherence remains poorly studied.

Methods: A cross-sectional study was conducted in health care facilities in Kinshasa among 506 PLHIV receiving outpatient ART. Socio-demographic, clinical, behavioural, and nutritional data were collected through structured interviews and medical record reviews. Chi-square tests and logistic regression analyses were performed using Stata version 17.0 software, with a statistical significance threshold set at P < 0.05.

Results: Proportion of ART nonadherence was 51.4%. Overall, 74.9% of participants were food insecure, including 56.5% with severe food insecurity. In multivariate analysis, severe food insecurity was strongly associated with nonadherence (adjusted odds ratio [aOR] = 5.98). Other predictors included alcohol use (aOR = 1.93), absence of viral load monitoring (aOR = 1.63), travel outside Kinshasa (aOR = 3.52), and being widowed or divorced (aOR = 2.18). ART refill intervals of 3-6 months were protective (aOR = 0.42).

Conclusion: Severe food insecurity significantly undermines ART adherence. Integrating targeted nutritional support into HIV programmes, alongside biomedical care, may help improve treatment adherence and support progress towards achieving the UNAIDS 95-95-95 goals.