O. Chukwuogo, C. Ogoamaka, O. Bethrand, U. Lotanna, O. Chidubem, U. Sani, N. Nkiru, B. Mamman, E. Daniel, O. Chijioke, N. Oloruntobi, I. Austin, N. Debby, E. Rupert, O. Omosalewa, U. Emperor, A. Chukwuma
INTRODUCTION: TB remains one of the leading causes of death in Nigeria, and despite progress in treatment coverage, a 56% gap in national case notifications remains. This gap is attributable in part to underdiagnosis due to missed cases in health facilities. The TB Surge intervention presented an opportunity to address barriers to optimal case detection in public health facilities. METHODS: KNCV Nigeria implemented the TB Surge intervention under the USAID-funded TB-LON Project in 1,041 public facilities from June 2020 to September 2022. Trained ad-hoc staff screened hospital attendees, linked identified presumptive TB cases to diagnosis and confirmed TB cases to treatment. Data were reported using the Commcare application. Robust project monitoring was used to address gaps. RESULTS: Of a total of 12,195,874 hospital attendees screened for TB, 729,369 identified as presumptive TB were tested and 65,029 TB cases were diagnosed; 8% of the TB cases were children. Overall TB yield was 9%. Medical ward service delivery point had the highest TB yield of 21%. The number needed to test was 11 and the number needed to screen was 188. CONCLUSION: The TB Surge intervention was of strategic importance in addressing missed cases and barriers to prompt TB diagnosis in health facilities.
{"title":"The TB Surge intervention: an optimized approach to TB case-finding in Nigeria","authors":"O. Chukwuogo, C. Ogoamaka, O. Bethrand, U. Lotanna, O. Chidubem, U. Sani, N. Nkiru, B. Mamman, E. Daniel, O. Chijioke, N. Oloruntobi, I. Austin, N. Debby, E. Rupert, O. Omosalewa, U. Emperor, A. Chukwuma","doi":"10.5588/pha.23.0039","DOIUrl":"https://doi.org/10.5588/pha.23.0039","url":null,"abstract":"INTRODUCTION: TB remains one of the leading causes of death in Nigeria, and despite progress in treatment coverage, a 56% gap in national case notifications remains. This gap is attributable in part to underdiagnosis due to missed cases in health facilities. The TB Surge intervention presented an opportunity to address barriers to optimal case detection in public health facilities. METHODS: KNCV Nigeria implemented the TB Surge intervention under the USAID-funded TB-LON Project in 1,041 public facilities from June 2020 to September 2022. Trained ad-hoc staff screened hospital attendees, linked identified presumptive TB cases to diagnosis and confirmed TB cases to treatment. Data were reported using the Commcare application. Robust project monitoring was used to address gaps. RESULTS: Of a total of 12,195,874 hospital attendees screened for TB, 729,369 identified as presumptive TB were tested and 65,029 TB cases were diagnosed; 8% of the TB cases were children. Overall TB yield was 9%. Medical ward service delivery point had the highest TB yield of 21%. The number needed to test was 11 and the number needed to screen was 188. CONCLUSION: The TB Surge intervention was of strategic importance in addressing missed cases and barriers to prompt TB diagnosis in health facilities.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"84 s372","pages":"136 - 141"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138622084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Myburgh, M. Kaur, P. Kaur, V. Santos, C. Almeida, G. Hoddinott, D. Wademan, P. V. M. Lakshmi, M. Osman, Sue-Ann Meehan, A. Hesseling, A. Purty, U. B. Singh, A. Trajman
BACKGROUND: Brazil, India and South Africa are among the top 30 high TB burden countries globally and experienced high rates of SARS-CoV-2 infection and mortality. The COVID-19 response in each country was unprecedented and complex, informed by distinct political, economic, social and health systems contexts. While COVID-19 responses have set back TB control efforts, they also hold lessons to inform future TB programming and services. METHODS: This was a qualitative exploratory study involving interviews with TB stakeholders (n = 76) in Brazil, India and South Africa 2 years into the COVID-19 pandemic. Interview transcripts were analysed using an inductive coding strategy. RESULTS: Political will – whether national or subnational – enabled implementation of widespread prevention measures during the COVID-19 response in each country and stimulated mobile and telehealth service delivery innovations. Participants in all three countries emphasised the importance of mobilising and engaging communities in public health responses and noted limited health education and information as barriers to implementing TB control efforts at the community level. CONCLUSIONS: Building political will and social mobilisation must become more central to TB programming. COVID-19 has shown this is possible. A similar level of investment and collaborative effort, if not greater, as that seen during the COVID-19 pandemic is needed for TB through multi-sectoral partnerships.
{"title":"Lessons for TB from the COVID-19 response: qualitative data from Brazil, India and South Africa","authors":"H. Myburgh, M. Kaur, P. Kaur, V. Santos, C. Almeida, G. Hoddinott, D. Wademan, P. V. M. Lakshmi, M. Osman, Sue-Ann Meehan, A. Hesseling, A. Purty, U. B. Singh, A. Trajman","doi":"10.5588/pha.23.0044","DOIUrl":"https://doi.org/10.5588/pha.23.0044","url":null,"abstract":"BACKGROUND: Brazil, India and South Africa are among the top 30 high TB burden countries globally and experienced high rates of SARS-CoV-2 infection and mortality. The COVID-19 response in each country was unprecedented and complex, informed by distinct political, economic, social and health systems contexts. While COVID-19 responses have set back TB control efforts, they also hold lessons to inform future TB programming and services. METHODS: This was a qualitative exploratory study involving interviews with TB stakeholders (n = 76) in Brazil, India and South Africa 2 years into the COVID-19 pandemic. Interview transcripts were analysed using an inductive coding strategy. RESULTS: Political will – whether national or subnational – enabled implementation of widespread prevention measures during the COVID-19 response in each country and stimulated mobile and telehealth service delivery innovations. Participants in all three countries emphasised the importance of mobilising and engaging communities in public health responses and noted limited health education and information as barriers to implementing TB control efforts at the community level. CONCLUSIONS: Building political will and social mobilisation must become more central to TB programming. COVID-19 has shown this is possible. A similar level of investment and collaborative effort, if not greater, as that seen during the COVID-19 pandemic is needed for TB through multi-sectoral partnerships.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"113 3","pages":"162 - 168"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138609583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SETTING: Air pollution, including particulate matter, causes health problems for residents of major cities around the world, including New Delhi, India. Public participation is important in framing policies related to such public health issues. OBJECTIVE: To study how the public’s comments on air pollution, which had been collected on the orders of the Indian Supreme Court, influenced air pollution policy in New Delhi. DESIGN: We filed a Right to Information Act, 2005 application with the Commission for Air Quality Management (CAQM) to obtain a copy of the comments. These were compiled and compared with key major areas identified in the policy released by the regulatory authority. RESULTS: There were a wide range of comments from experts, residents and resident associations. In total, 115 comments were compiled and studied, and several recurring themes were found to have been incorporated into the policy. This included the need to switch to green public transport and cycling, the use of alternative fuels and reduced agricultural crop residue burning. CONCLUSION: Our study revealed that the public and experts have indeed influenced the CAQM air pollution policy. This is important, as it highlights a democratic, inclusive and stakeholder-based approach. Nonetheless, a future concern lies in how this policy is translated into actionable regulations with effective implementation in the field.
{"title":"The importance of public participation in framing air pollution policy: outcome of a judicial review in New Delhi, India","authors":"Raja Singh, Amar Gf, A. Frank","doi":"10.5588/pha.23.0047","DOIUrl":"https://doi.org/10.5588/pha.23.0047","url":null,"abstract":"SETTING: Air pollution, including particulate matter, causes health problems for residents of major cities around the world, including New Delhi, India. Public participation is important in framing policies related to such public health issues. OBJECTIVE: To study how the public’s comments on air pollution, which had been collected on the orders of the Indian Supreme Court, influenced air pollution policy in New Delhi. DESIGN: We filed a Right to Information Act, 2005 application with the Commission for Air Quality Management (CAQM) to obtain a copy of the comments. These were compiled and compared with key major areas identified in the policy released by the regulatory authority. RESULTS: There were a wide range of comments from experts, residents and resident associations. In total, 115 comments were compiled and studied, and several recurring themes were found to have been incorporated into the policy. This included the need to switch to green public transport and cycling, the use of alternative fuels and reduced agricultural crop residue burning. CONCLUSION: Our study revealed that the public and experts have indeed influenced the CAQM air pollution policy. This is important, as it highlights a democratic, inclusive and stakeholder-based approach. Nonetheless, a future concern lies in how this policy is translated into actionable regulations with effective implementation in the field.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"17 4","pages":"169 - 172"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138621048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Margi B. Sheth, Raj Appartment, Choksipark, K. Shringarpure, B. Modi, R. Damor, L. Manikam
BACKGROUND: Health-seeking behaviour refers to patients’ choices regarding their preferred healthcare destination and the timing of seeking assistance for treatment. Patients with TB usually first approach the private sector and/or lose several months’ time in inappropriate diagnosis and treatment due to lack of awareness regarding the availability of standard treatment protocols. This can lead to poor outcomes such as drug-resistant TB (DR-TB) and/or death. METHODOLOGY: A cross-sectional study was conducted to examine the health-seeking pathway and delays in diagnosis and initiation of DR-TB treatment among patients registered with the DR-TB centre in Vadodara District (India). RESULTS: A total of 93 patients were enrolled in the study; the median age was 35 years (IQR 24–45). For the first visit, 59 (63%) patients chose a public healthcare facility, mainly because the facility was near their residence (n = 20, 21.5%). The median delay in reaching the first healthcare facility was 12 days (IQR 7.5–30). Delay in reaching second- and third-level care was respectively 25 days (IQR 9–68) and 16 days (IQR 4–67). CONCLUSION: Two-thirds of patients required visits to a second healthcare centre for diagnosis, while one third needed a third visit. The overall median delay for reaching the DR-TB centre was 60 days (IQR 26–122). The median duration from symptom onset to the first healthcare contact fell within the timeframe for screening symptoms in standard diagnosis.
{"title":"Health-seeking pathway of drug-resistant TB patients in Vadodara, India","authors":"Margi B. Sheth, Raj Appartment, Choksipark, K. Shringarpure, B. Modi, R. Damor, L. Manikam","doi":"10.5588/pha.23.0019","DOIUrl":"https://doi.org/10.5588/pha.23.0019","url":null,"abstract":"BACKGROUND: Health-seeking behaviour refers to patients’ choices regarding their preferred healthcare destination and the timing of seeking assistance for treatment. Patients with TB usually first approach the private sector and/or lose several months’ time in inappropriate diagnosis and treatment due to lack of awareness regarding the availability of standard treatment protocols. This can lead to poor outcomes such as drug-resistant TB (DR-TB) and/or death. METHODOLOGY: A cross-sectional study was conducted to examine the health-seeking pathway and delays in diagnosis and initiation of DR-TB treatment among patients registered with the DR-TB centre in Vadodara District (India). RESULTS: A total of 93 patients were enrolled in the study; the median age was 35 years (IQR 24–45). For the first visit, 59 (63%) patients chose a public healthcare facility, mainly because the facility was near their residence (n = 20, 21.5%). The median delay in reaching the first healthcare facility was 12 days (IQR 7.5–30). Delay in reaching second- and third-level care was respectively 25 days (IQR 9–68) and 16 days (IQR 4–67). CONCLUSION: Two-thirds of patients required visits to a second healthcare centre for diagnosis, while one third needed a third visit. The overall median delay for reaching the DR-TB centre was 60 days (IQR 26–122). The median duration from symptom onset to the first healthcare contact fell within the timeframe for screening symptoms in standard diagnosis.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":" 118","pages":"155 - 161"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138613536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Stillo, M. Frick, J. Galarza, S. Kondratyuk, A. Makone, L. McKenna, W. Vandevelde, P. Winarni, P. Agbassi
Multiple therapeutic options exist for people with drug-resistant TB (DR-TB), but there is an urgent need to improve access to novel compounds and regimens for people with difficult to treat forms of TB. In additional to formal research studies and clinical trials, other mechanisms of accessing promising new TB compounds need to be introduced as soon as these drugs have shown efficacy and safety in phase II trials. Pre-approval access programs for newer TB drugs such as bedaquiline, delamanid, and pretomanid all suffered from shortcomings. These can be addressed for the next generation of new TB drugs through a series of concerted actions by stakeholders at multiple levels. In this viewpoint, we advocate for transparent, accessible pre-approval access as a core element of person-centered care for DR-TB.
{"title":"Addressing the needs of people with extensively drug-resistant TB through pre-approval access to drugs and research","authors":"J. Stillo, M. Frick, J. Galarza, S. Kondratyuk, A. Makone, L. McKenna, W. Vandevelde, P. Winarni, P. Agbassi","doi":"10.5588/pha.23.0033","DOIUrl":"https://doi.org/10.5588/pha.23.0033","url":null,"abstract":"Multiple therapeutic options exist for people with drug-resistant TB (DR-TB), but there is an urgent need to improve access to novel compounds and regimens for people with difficult to treat forms of TB. In additional to formal research studies and clinical trials, other mechanisms of accessing promising new TB compounds need to be introduced as soon as these drugs have shown efficacy and safety in phase II trials. Pre-approval access programs for newer TB drugs such as bedaquiline, delamanid, and pretomanid all suffered from shortcomings. These can be addressed for the next generation of new TB drugs through a series of concerted actions by stakeholders at multiple levels. In this viewpoint, we advocate for transparent, accessible pre-approval access as a core element of person-centered care for DR-TB.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"21 36","pages":"126 - 129"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138624890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Denise Evans, Medical Abdou K Sillah, I. Devoid, J. J. Ndenkeh, G. Moonga, I. Loum, A. Touray, O. Owolabi, J. Sutherland, A. Rachow, O. Ivanova, B. Kampmann
OBJECTIVE: To determine the social impact of adult TB on child household contacts living in the Greater Banjul Area, The Gambia. METHODS: This was a prospective observational cohort study among adults (≥18 years) starting treatment for drug-susceptible pulmonary TB between June 2019 and July 2021 who reported having at least one child household contact. We collected data from 51 adults and 180 child contacts at the start of TB treatment (baseline) and again at 6 months of treatment. Participants were asked about expenses for school fees, healthcare, festivities and food security of child contacts. RESULTS: While school attendance of the child contacts remained largely unaffected, there was a significant drop in school performance at 6 months (P < 0.001). Furthermore, child contacts faced significant food insecurity in terms of food quantity and variety available, with up to a four-fold increase in some instances at 6 months compared to baseline (P < 0.001) CONCLUSION: Child contacts face a potential decline in school performance and risk of food insecurity. While a plethora of work is being undertaken to alleviate costs of care for TB patients, further emphasis is needed to ensure educational and social prosperity for child contacts, as adults with TB have socio-economic implications for the wider household.
{"title":"Socio-economic burden of TB and its impact on child contacts in The Gambia","authors":"Denise Evans, Medical Abdou K Sillah, I. Devoid, J. J. Ndenkeh, G. Moonga, I. Loum, A. Touray, O. Owolabi, J. Sutherland, A. Rachow, O. Ivanova, B. Kampmann","doi":"10.5588/pha.23.0025","DOIUrl":"https://doi.org/10.5588/pha.23.0025","url":null,"abstract":"OBJECTIVE: To determine the social impact of adult TB on child household contacts living in the Greater Banjul Area, The Gambia. METHODS: This was a prospective observational cohort study among adults (≥18 years) starting treatment for drug-susceptible pulmonary TB between June 2019 and July 2021 who reported having at least one child household contact. We collected data from 51 adults and 180 child contacts at the start of TB treatment (baseline) and again at 6 months of treatment. Participants were asked about expenses for school fees, healthcare, festivities and food security of child contacts. RESULTS: While school attendance of the child contacts remained largely unaffected, there was a significant drop in school performance at 6 months (P < 0.001). Furthermore, child contacts faced significant food insecurity in terms of food quantity and variety available, with up to a four-fold increase in some instances at 6 months compared to baseline (P < 0.001) CONCLUSION: Child contacts face a potential decline in school performance and risk of food insecurity. While a plethora of work is being undertaken to alleviate costs of care for TB patients, further emphasis is needed to ensure educational and social prosperity for child contacts, as adults with TB have socio-economic implications for the wider household.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"345 12","pages":"130 - 135"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138625930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A unique and colossal development in global health","authors":"G. N. Kazi","doi":"10.5588/pha.23.0049","DOIUrl":"https://doi.org/10.5588/pha.23.0049","url":null,"abstract":"","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":" 1172","pages":"179 - 180"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Keller, E. U. Mallari, J. F. Febre, J. Timbol, R. Powers, R. R. Peregrino, A. Slyzkii, C. Mulder, M. V. Magno, I. Spruijt
Self-testing for COVID-19 using antigen-detecting rapid diagnostic tests (Ag-RDTs) shows high promise in the Philippines. Self-testing has the potential to provide broader access to testing, empowering individuals by bringing healthcare services closer to them. We conducted 15 semi-structured interviews with health officers and decision-makers in the Philippines. These interviews explored the experiences and perspectives on the acceptability and feasibility of self-test use and implementation. We found that self-testing is easy-to-use, provides rapid results and can facilitate early detection. However, regulatory policies, linkages to care and effective health education plans must be in place for successful implementation.
{"title":"Feasibility and acceptability of COVID-19 self-testing in the Philippines","authors":"Sara Keller, E. U. Mallari, J. F. Febre, J. Timbol, R. Powers, R. R. Peregrino, A. Slyzkii, C. Mulder, M. V. Magno, I. Spruijt","doi":"10.5588/pha.23.0045","DOIUrl":"https://doi.org/10.5588/pha.23.0045","url":null,"abstract":"Self-testing for COVID-19 using antigen-detecting rapid diagnostic tests (Ag-RDTs) shows high promise in the Philippines. Self-testing has the potential to provide broader access to testing, empowering individuals by bringing healthcare services closer to them. We conducted 15 semi-structured interviews with health officers and decision-makers in the Philippines. These interviews explored the experiences and perspectives on the acceptability and feasibility of self-test use and implementation. We found that self-testing is easy-to-use, provides rapid results and can facilitate early detection. However, regulatory policies, linkages to care and effective health education plans must be in place for successful implementation.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":" 793","pages":"119 - 122"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SETTING: India has the highest number of new TB cases worldwide. The participation of private providers (PPs) in the National TB Elimination Programme (NTEP) has remained suboptimal. OBJECTIVE: To explore the experiences, barriers and facilitators about their participation in the NTEP as perceived by PPs working in varied settings. DESIGN: Focus group discussions and in-depth interviews were used to engage PPs to obtain their views on participation in the NTEP. Framework and thematic content analysis was used to analyse qualitative data. RESULTS: Non-availability of a comprehensive range of diagnostics and lack of flexibility in the NTEP were barriers to participation in NTEP. PPs were predisposed to think that NTEP was for those who could not afford to purchase medications. Attitudes and previous experiences with NTEP made them sceptical about the NTEP regimen. Although more frequent interactions were sought with NTEP, some bitterness about previous interactions was perceived. CONCLUSION: Challenges identified by PPs for the NTEP include improvement of the quality of TB care, especially at the lower levels of care, availability of a comprehensive range of diagnostics, being friendly to PPs and patients, more frequent interactions with PPs, and more caring conversations with patients at NTEP centres.
{"title":"Participation of private providers in the National TB Programme in South India","authors":"Anand D Meundi, J. Richardus","doi":"10.5588/pha.23.0032","DOIUrl":"https://doi.org/10.5588/pha.23.0032","url":null,"abstract":"SETTING: India has the highest number of new TB cases worldwide. The participation of private providers (PPs) in the National TB Elimination Programme (NTEP) has remained suboptimal. OBJECTIVE: To explore the experiences, barriers and facilitators about their participation in the NTEP as perceived by PPs working in varied settings. DESIGN: Focus group discussions and in-depth interviews were used to engage PPs to obtain their views on participation in the NTEP. Framework and thematic content analysis was used to analyse qualitative data. RESULTS: Non-availability of a comprehensive range of diagnostics and lack of flexibility in the NTEP were barriers to participation in NTEP. PPs were predisposed to think that NTEP was for those who could not afford to purchase medications. Attitudes and previous experiences with NTEP made them sceptical about the NTEP regimen. Although more frequent interactions were sought with NTEP, some bitterness about previous interactions was perceived. CONCLUSION: Challenges identified by PPs for the NTEP include improvement of the quality of TB care, especially at the lower levels of care, availability of a comprehensive range of diagnostics, being friendly to PPs and patients, more frequent interactions with PPs, and more caring conversations with patients at NTEP centres.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":" 22","pages":"142 - 147"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138612933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Hacking, V. V. Gwenin, R. J. Dacombe, M. S. Baird, M. Frimpong, R. O. Phillips, C. D. Gwenin
SETTING: The diagnosis of Buruli ulcer (BU) is frequently made by experienced health workers in rural regions. This leads to long turnaround times to confirm the diagnosis as it requires specialised laboratory infrastructure to perform confirmatory testing. BACKGROUND: Given the lack of success with protein antigens to detect BU in human sera, the aim of this study was to evaluate a range of single synthetic lipid antigens using an enzyme-linked immunosorbent assay (ELISA). The ELISA system used was initially developed to detect TB using single synthetic lipid antigens. METHODS: Thirty polymerase chain reaction (PCR) positive BU samples and 30 PCR-negative healthy contact samples collected from Asante Akim North and Ahafo Ano North Districts, Ghana, that are endemic for BU between 2013 and 2016 were used to evaluate the synthetic lipid antigen ELISA. A Quantikine ELISA was also conducted on a randomly blinded sub-set of 30 samples. RESULTS: The synthetic lipid ELISA evaluated here outperforms all other ELISA tests using protein antigens to detect BU to date and has shown potential as a fast (2 h) test for BU which may be adapted for use at the point of care. A sensitivity of 63% and specificity of 80% was observed for 30 BU-positive and 30 BU-negative samples, with significantly reduced interleukin-8 (IL-8) levels in a subset of patients with BU. CONCLUSION: A single lipid was shown for the first time to have the ability to distinguish between PCR-positive BU and negative sera using ELISA. The low lipid antibody load detected may be a result of immune suppression caused by the presence of mycolactone in patients with BU, given that levels of IL-8 were significantly reduced in patients with BU compared to the control serum samples.
背景:布鲁里溃疡(BU)的诊断通常由农村地区经验丰富的卫生工作者做出。这导致确认诊断的周转时间较长，因为它需要专门的实验室基础设施来进行确认测试。背景:鉴于缺乏成功的蛋白质抗原检测人血清中的布鲁里溃疡，本研究的目的是利用酶联免疫吸附试验(ELISA)评估一系列单一合成脂质抗原。ELISA系统最初用于使用单一合成脂质抗原检测结核病。方法:采用2013 - 2016年在加纳Asante Akim North和Ahafo Ano North地区采集的30例布鲁里溃疡聚合酶链反应(PCR)阳性样本和30例PCR阴性健康接触者样本，对合成脂质抗原ELISA进行评价。对随机盲法的30个样本进行定量酶联免疫吸附试验。结果:本文评估的合成脂质酶联免疫吸附试验优于迄今为止使用蛋白质抗原检测布鲁里溃疡的所有其他酶联免疫吸附试验，并显示出作为布鲁里溃疡快速(2小时)检测的潜力，可能适用于护理点。在30例BU阳性和30例BU阴性样本中，观察到敏感性为63%，特异性为80%，在一部分BU患者中，白细胞介素-8 (IL-8)水平显著降低。结论:首次发现一种脂质具有区分pcr阳性和阴性血清的能力。考虑到与对照血清样本相比，布鲁里溃疡患者的IL-8水平显著降低，检测到的低脂抗体负荷可能是由于布鲁里溃疡患者中霉菌内酯的存在引起的免疫抑制。
{"title":"A single synthetic lipid antigen for improved serological diagnosis of Buruli ulcer","authors":"J. Hacking, V. V. Gwenin, R. J. Dacombe, M. S. Baird, M. Frimpong, R. O. Phillips, C. D. Gwenin","doi":"10.5588/pha.23.0038","DOIUrl":"https://doi.org/10.5588/pha.23.0038","url":null,"abstract":"SETTING: The diagnosis of Buruli ulcer (BU) is frequently made by experienced health workers in rural regions. This leads to long turnaround times to confirm the diagnosis as it requires specialised laboratory infrastructure to perform confirmatory testing. BACKGROUND: Given the lack of success with protein antigens to detect BU in human sera, the aim of this study was to evaluate a range of single synthetic lipid antigens using an enzyme-linked immunosorbent assay (ELISA). The ELISA system used was initially developed to detect TB using single synthetic lipid antigens. METHODS: Thirty polymerase chain reaction (PCR) positive BU samples and 30 PCR-negative healthy contact samples collected from Asante Akim North and Ahafo Ano North Districts, Ghana, that are endemic for BU between 2013 and 2016 were used to evaluate the synthetic lipid antigen ELISA. A Quantikine ELISA was also conducted on a randomly blinded sub-set of 30 samples. RESULTS: The synthetic lipid ELISA evaluated here outperforms all other ELISA tests using protein antigens to detect BU to date and has shown potential as a fast (2 h) test for BU which may be adapted for use at the point of care. A sensitivity of 63% and specificity of 80% was observed for 30 BU-positive and 30 BU-negative samples, with significantly reduced interleukin-8 (IL-8) levels in a subset of patients with BU. CONCLUSION: A single lipid was shown for the first time to have the ability to distinguish between PCR-positive BU and negative sera using ELISA. The low lipid antibody load detected may be a result of immune suppression caused by the presence of mycolactone in patients with BU, given that levels of IL-8 were significantly reduced in patients with BU compared to the control serum samples.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":" 5","pages":"173 - 178"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138621112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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