Tuberculosis active case finding and management of advanced HIV disease in rural Mozambique
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CovenanteeManhiça Health Research Centre; Institut de Salut Global Barcelona; CDC Foundation; STOP-TB Partnership - TB Reach
Document typeBachelor thesis
Rights accessRestricted access - author's decision
Tuberculosis (TB) and human immunodeficiency Virus (HIV) are considered as major global health concerns. According to the World Health Organization (WHO), TB and HIV are the two infectious diseases causing more deaths worldwide. In 2017 10.0 and 1.8 million people were newly infected by TB and HIV respectively. In the same year 2.1 million people died from these diseases worldwide. In particular, Mozambique is one of the world's regions more hardly affected by these epidemics, with 163,000 new TB cases and 150,000 new HIV infections in 2017. Interdependence between both diseases is high, with 40% of the people living with TB in Mozambique also being HIV positive. One of the major challenges in these regions remains as the low-case detection rates for both pathogens. Active case finding (ACF) strategies have often been used to reduce the number of undetected people living in the community. However, these strategies often fail in their capacity to effectively deploy their interventions in an integrated and cost-effective manner. Innovative strategies are needed to identify these diseases early in the community and improve outcomes of people living with HIV (PLHIV) and TB in sub-Saharan Africa. In 2018 a TB ACF study was implemented in the Manhiça district, Mozambique (population ~180,000). Through this intervention community health workers reached all household and community contacts of every new TB case reported in any of the health centres of the district. Participants were tested for HIV and for TB (Xpert® MTB/RIF Ultra in induced sputum). Participants newly detected with TB were referred to the National Tuberculosis Control Program for clinical evaluation and timely TB treatment initiation. All PLHIV identified to be on treatment received a nonadherence questionnaire, those who reported poor antiretroviral therapy (ART)-adherence or who were ART-naïve were invited to be referred to the Manhiça District Hospital to receive screening of advanced HIV disease (AHD). Patients with AHD (CD4 counts < 200 cells/mm3 or WHO stage 3 or 4), were offered a package of interventions recommended by the WHO including screening, treatment and/or prophylaxis for opportunistic infections, rapid ART initiation and adherence support. Throughout this intervention, all information was collected digitally using electronic case report forms (eCRF) which daily generated large volumes of data. Business Intelligence (BI) tools were used to create a real-time data surveillance platform to monitor the progress of this intervention. The preliminary results of this intervention, together with the data management approach of this study and the view obtained from the implementation of self-reported adherence questionnaires, suggest that potential benefits may lie within the implementation of ACF strategies through an interdisciplinary point of view. Furthermore, due to the strong interdependence between TB and HIV, ACF strategies offer a great platform to implement holistic approaches for epidemiologic control of TB, HIV and other related comorbidities.
SubjectsEpidemiology, VIH (Virus) -- Prevenció -- Països en vies de desenvolupament, Tuberculosi -- Prevenció -- Països en vies de desenvolupament