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1. Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM): Implications for HIV and STI transmission.

Author

Adedimeji, Adebola, Sinayobye, Jean d'Amour, Asiimwe-Kateera, Brenda, Chaudhry, Junaid, Buzinge, Lydia, Gitembagara, Andre, Murenzi, Gad, Mugenzi, Pacifique, Patel, Viraj V, Castle, Philip E, Mutesa, Leon, Palefsky, Joel, and Anastos, Kathryn M

Subjects
Humans, HIV-1, Acquired Immunodeficiency Syndrome, Prevalence, Homosexuality, Male, Socioeconomic Factors, Adolescent, Adult, Rwanda, Male, Sexual and Gender Minorities, Health Risk Behaviors, Homosexuality, General Science & Technology
Abstract

IntroductionMen who have sex with men (MSM) are disproportionately impacted by HIV/AIDS resulting from risky sexual behaviors. Social and contextual factors are known to mediate risk behaviors, but there is limited information about the prevalence of risky sexual practices of Rwandan MSM and the concomitant socio-contextual determinants making it difficult to assess implications for preventing HIV/STI transmission in this key population.MethodsUsing exploratory qualitative design, we obtained socio-contextual information regarding prevalence of risky sexual behavior and assessed implications for HIV/ STIs transmission and preventive measures taken by MSM to improve sexual health and wellbeing. Thirty MSM were recruited to participate in in-depth interviews using respondent-driven sampling from LGBT associations in Kigali. Data were analyzed using standard qualitative data analysis procedures.ResultsRespondents' were between 18-40 years old; all completed primary education and are mostly low-socioeconomic status. Risky sexual practices were common, but differed by peculiar individual and contextual factors. Older MSM often reported occasional sexual relations with women to avoid suspicion and social stigma. Younger MSM's risky sexual practices are mostly transactional and mediated by the need for social acceptance and support. Knowledge of STIs was poor, but prevalence, especially of HPV was high. The options for improving sexual wellbeing are limited and mostly clandestine.ConclusionRisky sexual behavior of Rwandan MSM has major implications for HIV/STI transmission. An environment of intense social stigma and social isolation makes it difficult to obtain information or services to improve sexual health. Effective interventions that address individual and contextual determinants of risk and access to health services are urgently needed to limit the consequence of MSM as a bridge for HIV transmission to the general population.

Published
2019

2. Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM): Implications for HIV and STI transmission.

Author

Adebola Adedimeji, Jean d'Amour Sinayobye, Brenda Asiimwe-Kateera, Junaid Chaudhry, Lydia Buzinge, Andre Gitembagara, Gad Murenzi, Pacifique Mugenzi, Viraj V Patel, Philip E Castle, Leon Mutesa, Joel Palefsky, and Kathryn M Anastos

Subjects
Medicine, Science
Abstract

IntroductionMen who have sex with men (MSM) are disproportionately impacted by HIV/AIDS resulting from risky sexual behaviors. Social and contextual factors are known to mediate risk behaviors, but there is limited information about the prevalence of risky sexual practices of Rwandan MSM and the concomitant socio-contextual determinants making it difficult to assess implications for preventing HIV/STI transmission in this key population.MethodsUsing exploratory qualitative design, we obtained socio-contextual information regarding prevalence of risky sexual behavior and assessed implications for HIV/ STIs transmission and preventive measures taken by MSM to improve sexual health and wellbeing. Thirty MSM were recruited to participate in in-depth interviews using respondent-driven sampling from LGBT associations in Kigali. Data were analyzed using standard qualitative data analysis procedures.ResultsRespondents' were between 18-40 years old; all completed primary education and are mostly low-socioeconomic status. Risky sexual practices were common, but differed by peculiar individual and contextual factors. Older MSM often reported occasional sexual relations with women to avoid suspicion and social stigma. Younger MSM's risky sexual practices are mostly transactional and mediated by the need for social acceptance and support. Knowledge of STIs was poor, but prevalence, especially of HPV was high. The options for improving sexual wellbeing are limited and mostly clandestine.ConclusionRisky sexual behavior of Rwandan MSM has major implications for HIV/STI transmission. An environment of intense social stigma and social isolation makes it difficult to obtain information or services to improve sexual health. Effective interventions that address individual and contextual determinants of risk and access to health services are urgently needed to limit the consequence of MSM as a bridge for HIV transmission to the general population.

Published
2019
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3. Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM): Implications for HIV and STI transmission

Author

Joel M. Palefsky, Kathryn Anastos, Philip E. Castle, Jean d’Amour Sinayobye, Andre Gitembagara, Brenda Asiimwe-Kateera, Junaid Chaudhry, Adebola Adedimeji, Lydia Buzinge, Pacifique Mugenzi, Gad Murenzi, Viraj V. Patel, Leon Mutesa, and Galea, Jerome T

Subjects
RNA viruses, Male, Pediatric AIDS, Social stigma, Epidemiology, Social Sciences, Human sexuality, Pathology and Laboratory Medicine, Men who have sex with men, Geographical Locations, Health Risk Behaviors, Sexual and Gender Minorities, 0302 clinical medicine, 5. Gender equality, Immunodeficiency Viruses, Medicine and Health Sciences, Prevalence, Psychology, Public and Occupational Health, 030212 general & internal medicine, Homosexuality, Social isolation, Aetiology, 10. No inequality, Reproductive health, media_common, Pediatric, education.field_of_study, Multidisciplinary, virus diseases, 3. Good health, Infectious Diseases, Medical Microbiology, HIV epidemiology, Viral Pathogens, Viruses, Medicine, HIV/AIDS, medicine.symptom, Pathogens, social and economic factors, 0305 other medical science, Behavioral and Social Aspects of Health, Infection, Clinical psychology, Research Article, Adolescent Sexual Activity, Adult, Adolescent, General Science & Technology, media_common.quotation_subject, Science, Population, Sexually Transmitted Diseases, Men WHO Have Sex with Men, Sexual and Gender Minorities (SGM/LGBT*), Microbiology, Interpersonal Relationships, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Clinical Research, 2.3 Psychological, Retroviruses, Behavioral and Social Science, medicine, Humans, Homosexuality, Male, education, Microbial Pathogens, Behavior, Acquired Immunodeficiency Syndrome, 030505 public health, business.industry, Prevention, Lentivirus, Organisms, Rwanda, Biology and Life Sciences, HIV, medicine.disease, Collective Human Behavior, Good Health and Well Being, Socioeconomic Factors, People and Places, Africa, HIV-1, Sexually Transmitted Infections, Population Groupings, Human Sexual Behavior, business, Sexuality Groupings
Abstract

Author(s): Adedimeji, Adebola; Sinayobye, Jean d'Amour; Asiimwe-Kateera, Brenda; Chaudhry, Junaid; Buzinge, Lydia; Gitembagara, Andre; Murenzi, Gad; Mugenzi, Pacifique; Patel, Viraj V; Castle, Philip E; Mutesa, Leon; Palefsky, Joel; Anastos, Kathryn M | Abstract: IntroductionMen who have sex with men (MSM) are disproportionately impacted by HIV/AIDS resulting from risky sexual behaviors. Social and contextual factors are known to mediate risk behaviors, but there is limited information about the prevalence of risky sexual practices of Rwandan MSM and the concomitant socio-contextual determinants making it difficult to assess implications for preventing HIV/STI transmission in this key population.MethodsUsing exploratory qualitative design, we obtained socio-contextual information regarding prevalence of risky sexual behavior and assessed implications for HIV/ STIs transmission and preventive measures taken by MSM to improve sexual health and wellbeing. Thirty MSM were recruited to participate in in-depth interviews using respondent-driven sampling from LGBT associations in Kigali. Data were analyzed using standard qualitative data analysis procedures.ResultsRespondents' were between 18-40 years old; all completed primary education and are mostly low-socioeconomic status. Risky sexual practices were common, but differed by peculiar individual and contextual factors. Older MSM often reported occasional sexual relations with women to avoid suspicion and social stigma. Younger MSM's risky sexual practices are mostly transactional and mediated by the need for social acceptance and support. Knowledge of STIs was poor, but prevalence, especially of HPV was high. The options for improving sexual wellbeing are limited and mostly clandestine.ConclusionRisky sexual behavior of Rwandan MSM has major implications for HIV/STI transmission. An environment of intense social stigma and social isolation makes it difficult to obtain information or services to improve sexual health. Effective interventions that address individual and contextual determinants of risk and access to health services are urgently needed to limit the consequence of MSM as a bridge for HIV transmission to the general population.

Published
2019

4. Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control ('Three I's') and HIV-Tuberculosis Service Integration in Lower Income Countries

Author

Charles, M.K., Lindegren, M.L., Wester, C.W., Blevins, M., Sterling, T.R., Dung, N.T., Dusingize, J.C., Avit-Edi, D., Durier, N., Castelnuovo, B., Nakigozi, G., Cortes, C.P., Ballif, M., Fenner, L., Ajayi, S., Anastos, K., Bashi, J., Bishai, W., Boulle, A., Braitstein, P., Carriquiry, G., Carter, J.E., Cegielski, P., Chimbetete, C., Davies, M.-A., Diero, L., Duda, S., Egger, M., Eboua, T.F., Gasser, A., Geng, E., Gnokori, J.C., Hardwicke, L., Hoffmann, C., Huebner, R., Kancheya, N., Kiertiburanakul, S., Kim, P., Lameck, D., Leroy, V., Lewden, C., Mandalakas, A., Maskew, M., McKaig, R., Mofenson, L., Mpoudi-Etame, M., Okwara, B., Phiri, S., Prasitsuebsai, W., Petit, A., Prozesky, H., Reid, S.E., Renner, L., Reubenson, G., Sohn, A., Vo, Q., Walker, D., Wehbe, F., Wejse, C., Williams, C., Wood, R., Wools-Kaloustian, K., Yao, Z., Yunihastuti, E., Zhang, F.J., Zhao, H.X., Han, N., Merati, T.P., Wirawan, D.N., Yuliana, F., Ditangco, R., Uy, E., Bantique, R., Phanuphak, P., Ruxrungtham, K., Avihingsanon, A., Khongphattanayothin, M., Sungkanuparph, S., Sanmeema, N., Chaiwarith, R., Sirisanthana, T., Kotarathititum, W., Pham, T.T., Cuong, D.D., Ha, H.L., Nguyen, V.K., Bui, V.H., Nguyen, T.D., Sohn, A.H., Petersen, B., Cooper, D.A., Law, M.G., Jiamsakul, A., Boettiger, D.C., Wati, D.K., Atmikasari, L.P.P., Malino, I.Y., Nallusamy, R., Chan, K.C., Lumbiganon, P., Kosalaraksa, P., Tharnprisan, P., Udomphanit, T., Phongsamart, W., Wittawatmongkol, O., Dung, K.T.K., Lam, N.V., An, P.N., Loan, N.T., Truong, H.K., Du, T.Q., Chau, N.H., Do, C.V., Ha, M.T., Nipathakosol, P., Kariminia, A., Mutimura, E., Gitembagara, A., Tatwangire, J., Izabelle, I., Niyongabo, T., Twizere, C., Baramperanye, E., Edmonds, A., Yotebieng, M., Azinyue, I., Ayangma, L., Dickinson, D., Eley, B., Fritz, C., Garone, D., Giddy, J., MacPhail, P., Moultrie, H., Ndirangu, J., Pestilli, S., Rabie, H., Stringer, J., Technau, K., Graber, C., Kaeser, F., Keiser, O., Cornell, M., Maxwell, N., Zannou, D.M., Ahouada, C., Akakpo, J., Ahomadegbé, C., Gougounon-Houéto, A., Azon-Kouanou, A., Houngbé, F., Sehonou, J., Koumakpaï, S., Alihonou, F., D'Almeida, M., Hodonou, I., Hounhoui, G., Sagbo, G., Tossa-Bagnan, L., Adjide, H., Drabo, J., Bognounou, R., Dienderé, A., Traore, E., Zoungrana, L., Zerbo, B., Sawadogo, A.B., Zoungrana, J., Héma, A., Soré, I., Bado, G., Tapsoba, A., Yé, D., Kouéta, F., Ouedraogo, S., Ouédraogo, R., Hiembo, W., Gansonré, M., Messou, E., Gnokoro, J.C., Koné, M., Kouakou, G.M., Bosse, C.A., Brou, K., Assi, A.I., Chenal, H., Hawerlander, D., Soppi, F., Minga, A., Abo, Y., Yoboue, J.-M., Eholié, S.P., Amego, M.D.N., Andavi, V., Diallo, Z., Ello, F., Tanon, A.K., Koule, S.O., Anzan, K.C., Guehi, C., Aka, E.A., Issouf, K.L., Kouakou, J.-C., N'Gbeche, M.-S., Pety, T., Kouakou, K., Moh, M., Yao, V.A., Folquet, M.A., Dainguy, M.-E., Kouakou, C., Méa-Assande, V.T., Oka-Berete, G., Zobo, N., Acquah, P., Kokora, M.-B., Timité-Konan, M., Ahoussou, L.D., Assouan, J.K., Sami, M.F., Kouadio, C., Goka, B., Welbeck, J., Sackey, A., Owiafe, S.N., Da Silva, Z.J., Paulo, J., Rodrigues, A., Da Silva, D., Medina, C., Oliviera-Souto, I., Østergaard, L., Laursen, A., Sodemann, M., Aaby, P., Fomsgaard, A., Erikstrup, C., Eugen-Olsen, J., Maïga, M.Y., Diakité, F.F., Kalle, A., Katile, D., Traore, H.A., Minta, D., Cissé, T., Dembelé, M., Doumbia, M., Fomba, M., Kaya, A.S., Traoré, A.M., Traoré, H., Toure, A.A., Dicko, F., Sylla, M., Berthé, A., Traoré, H.C., Koïta, A., Koné, N., N'Diaye, C., Coulibaly, S.T., Traoré, M., Traoré, N., Charurat, M., Alim, G., Dapiap, S., Otu, Igbinoba, F., Benson, O., Adebamowo, C., James, J., Obaseki, Osakede, P., Olasode, J., Seydi, M., Sow, P.S., Diop, B., Manga, N.M., Tine, J.M., Bassabi, C.C., Sy, H.S., Ba, A., Diagne, A., Dior, H., Faye, M., Gueye, R.D., Mbaye, A.D., Patassi, A., Kotosso, A., Kariyare, B.G., Gbadamassi, G., Komi, A., Mensah-Zukong, K.E., Pakpame, P., Lawson-Evi, A.K., Atakouma, Y., Takassi, E., Djeha, A., Ephoévigah, A., Djibril, S.E.-H., Dabis, F., Bissagnene, E., Arrivé, E., Coffie, P., Ekouevi, D., Jaquet, A., Sasco, A.J., Amani, D., Azani, J.-C., Balestre, E., Bessekon, S., Bohossou, F., Gilbert, C., Karcher, S., Gonsan, J.M., Le Carrou, J., Lenaud, S., Nchot, C., Malateste, K., Yao, A.R., Siloué, B., Clouet, G., Dosso, M., Doring, A., Kouakou, A., Rabourdin, E., Rivenc, J., Anglaret, X., Ba, B., Essanin, J.B., Ciaranello, A., Datté, S., Desmonde, S., Diby, J.-S.E., Gottlieb, G.S., Horo, A.G., Kangah, S.N., Malvy, D., Meless, D., Mounkaila-Harouna, A., Ndondoki, C., Shiboski, C., Tchounga, B., Thiébaut, R., Wandeler, G., McGowan, C., Cahn, P., Gotuzzo Herencia, José Eduardo, Reyes, M.W., Grinsztejn, B., Pape, J.W., Padgett, D., and Madero, J.S.

Subjects
0301 basic medicine, Program evaluation, Bacterial Diseases, poverty, Physiology, Antitubercular Agents, lcsh:Medicine, HIV Infections, Pathology and Laboratory Medicine, Occupational safety and health, Geographical Locations, 0302 clinical medicine, case finding, Health care, lowest income group, Medicine and Health Sciences, Coughing, Medicine, Infection control, 030212 general & internal medicine, lcsh:Science, fever, Multidisciplinary, antiretrovirus agent, adult, HIV diagnosis and management, sputum smear, Vaccination and Immunization, 3. Good health, Infectious Diseases, Caribbean Region, Tuberculosis Diagnosis and Management, protective equipment, tuberculosis control, Research Article, medicine.medical_specialty, isoniazid, Tuberculosis, Asia, integrated health care system, 030106 microbiology, HIV prevention, Immunology, Developing country, Antiretroviral Therapy, complication, 610 Medicine & health, World Health Organization, Article, 03 medical and health sciences, Signs and Symptoms, Tuberculosis diagnosis, Antiviral Therapy, Human immunodeficiency virus infection, night sweat, 360 Social problems & social services, Environmental health, parasitic diseases, Isoniazid, Humans, purl.org/pe-repo/ocde/ford#3.01.05 [https], human, coughing, Poverty, tuberculin test, Caribbean, Preventive medicine, Infection Control, AIDS-Related Opportunistic Infections, business.industry, screening, lcsh:R, Biology and Life Sciences, occupational safety, South America, medicine.disease, Tropical Diseases, Diagnostic medicine, mask, Public and occupational health, purl.org/pe-repo/ocde/ford#3.02.07 [https], People and Places, Africa, Physical therapy, tuberculostatic agent, lcsh:Q, weight reduction, business, Physiological Processes
Abstract

SETTING World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV. OBJECTIVE To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries. DESIGN Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa. RESULTS ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03). CONCLUSIONS Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.

Published
2016

5. Optimizing Nursing and Midwifery Practice in Rwanda

Author

Andre Gitembagara, Renee Pyburn, and Michael V. Relf

Subjects
Nursing practice, education.field_of_study, medicine.medical_specialty, business.industry, Obstetrics, Nurse staffing, Population, Staffing, General Medicine, Genocide, Nursing, Rwanda, nursing practice, midwifery practice, nurse staffing, East Africa, Health care, East africa, Medicine, Descriptive research, business, education
Abstract

Following the 1994 genocide in Rwanda, the number of nurses remaining in practice in Rwanda was critically low. Since that time the leaders of Rwanda have worked diligently to increase both the number of nurses in Rwanda and their level of education. They have also set goals for the number of healthcare workers that should be in each facility according to the population in the catchment area. In 2015, a cross sectional, descriptive study was done to evaluate the gaps between the targeted number of the nurses and midwives in the health centers and district hospitals in Rwanda and the actual numbers in these facilities. Results indicated that in health centers staffing levels were at 55% of recommended levels, and in district hospitals 80.5% of recommended staffing levels. Looking to the future, Rwanda must focus not only on staffing numbers but also evaluate the practice environment, healthcare system, and the roles and responsibility of nurses and midwives. Education systems must also prioritize ensuring that entry-level nurses and midwives enter into the profession with essential competencies for safe practice, that interdisciplinary team practice is a part of the curriculum, and that nurses and midwives are educated beyond the associate nurse level. Keywords: Rwanda, nursing practice, midwifery practice, nurse staffing, East Africa

Published
2015

6. Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries

Author

I. Izabelle, F. Ello, H. Ssemuwemba, S. Phiri, J. Olasode, Marie-Sylvie N’Gbeche, S. Kouadio, Jesper Eugen-Olsen, M. Mpoudi-Etame, Cristin Q. Fritz, S. Dapiap, J. Zoungrana, Antoine Jaquet, Aristophane Tanon, Rasmata Ouédraogo, N. T. Loan, E. J. Carter, Obaseki, F. F. Diakité, H. X. Zhao, Kulkanya Chokephaibulkit, Z. J. da Silva, Peter Aaby, Dewi Kumara Wati, David da Silva, L. Ayangma, K. Jjingo, P. Kim, Romanee Chaiwarith, James Ndirangu, Valériane Leroy, L. P. P. Atmikasari, N. Zobo, H. Chenal, Rita Lyamuya, Catherine C. McGowan, Keswadee Lapphra, Wanatpreeya Phongsamart, B. B. Mwebesa, Théodore Niyongabo, D. Katile, B. Ba, Matthias Egger, L. Mofenson, A. Mounkaila-Harouna, Boris Tchounga, M. Moh, Elom Takassi, Haby Signaté Sy, G. Sagbo, F. Kaeser, Eduardo Gotuzzo, Guillaume Bado, C. C. McGowan, S. Karcher, Constantin T. Yiannoutsos, V. H. Bui, Christopher J. Hoffmann, Didier K. Ekouevi, J. Akakpo, I. Azinyue, S. Kiertiburanakul, S. O. Koule, W. Bishai, Mariam Guindo Traoré, C. Williams, Elise Arrivé, A. Tapsoba, S. Bessekon, Patrick A. Coffie, F. Yuliana, A. Gougounon-Houéto, Somnuek Sungkanuparph, Y. Abo, Q. Vo, Praphan Phanuphak, M. B. Kokora, Kouadio Kouakou, Fla Kouéta, M. E. Dainguy, O. Benson, I. Soré, W. Prasitsuebsai, Harry Moultrie, C. Guehi, Beatriz Grinsztejn, T. Q. Du, L. Diecket Ahoussou, Z. Diallo, N. Traoré, Firas Wehbe, C. V. Do, J. Tatwangire, A. Kotosso, F. Soppi, Amabelia Rodrigues, Juan Sierra Madero, P. S. Sow, Rodolphe Thiébaut, I. Y. Malino, Moussa Seydi, Helena Rabie, A. Dienderé, Geoffrey Somi, Emmanuel Bissagnene, Elizabeth A. Bukusi, H. C. Traoré, David A. Cooper, N. M. Manga, P. Osakede, S. Ajayi, J. Paulo, Marguerite Timite-Konan, Andrew Edmonds, B. Diop, A. M. Traoré, W. Hiembo, A. Koïta, M. Faye, A. Azon-Kouanou, Christian Wejse, Claudia P. Cortes, T. Pety, N. Durier, Thira Sirisanthana, Camille Ndondoki, Karl-Günter Technau, J. S. Elvis Diby, G. Alim, M. D'Almeida, A. Komi, J. Bashi, J. M. Tine, D. Hawerlander, R. Ditangco, Akouda Patassi, A. Kalle, F. J. Zhang, Lorna Renner, N. H. Chau, Janet Giddy, G. Clouet, Samwel O. Ayaya, A. Sohn, Lars Østergaard, Sylvie Ouédraogo, Clement Adebamowo, Azar Kariminia, John Ssali, Joseph Drabo, M. Dembelé, Nicola Maxwell, Albert Minga, M. D.N. Amego, Wilai Kotarathititum, Christian Erikstrup, H. A. Traore, Kapella Zacharia Ngonyani, E. Geng, Lukas Fenner, A. Diagne, Marcelo Wolff, A. I. Assi, A. Sackey, A. R. Yao, M. F. Sami, Edmond Addi Aka, H. Adjide, Pagakrong Lumbiganon, Karen Malateste, L. Diero, M. Gansonré, P. N. An, A. H. Sohn, D. Meless, D. Avit-Edi, D. Walker, L. Hardwicke, A. S. Kaya, Véronique Mea-Assande, G. S. Gottlieb, Denis Padgett, Eric Balestre, Candida Medina, D. Amani, C. Kouakou, C. Shiboski, E Messou, B. G. Kariyare, M. Ballif, W. Wester, J. M. Gonsan, G. Gbadamassi, A. Ba, M. Fomba, Denis Malvy, R. Bantique, S. N. Owiafe, Andrew Kambugu, Festus Igbinoba, M. Y. Maiga, C. Ahomadegbé, A. Berthé, R. D. Gueye, C. C. Bassabi, Djimon Marcel Zannou, Olivia Keiser, Kara Wools-Kaloustian, K. E. Mensah-Zukong, A. Doring, C. Chimbetete, J. Rivenc, V. Andavi, F. Alihonou, S. Datté, S. Pestilli, T. Mengthaisong, Kathryn Anastos, A. D. Mbaye, D. Lameck, Claire Graber, J. Lewis-Kulzer, G. Reubenson, B. Siloué, Marcel Yotebieng, K. T.K. Dung, C. Ahouada, Severin Lenaud, J. Welbeck, D. Dickinsonn, L. Zoungrana, A. Avihingsanon, T. T. Cao, V. K. Nguyen, Morten Sodemann, J. C. Dusingize, B. Okwara, C. Lewden, H. Traoré, Patrick MacPhail, David C Boettiger, G. Oka-Berete, H. K. Truong, F. Houngbé, Robin Wood, Venerandah Nhandu, J. C. Azani, G. Wandeler, K. L. Issouf, K. C. Anzan, Andrea L. Ciaranello, Awachana Jiamsakul, M. T. Ha, K. Brou, M. Maskew, L. Tossa-Bagnan, B. Zerbo, P. Pakpame, Xavier Anglaret, Jean W. Pape, J. B. Essanin, A. Petit, A. Kouakou, E. Rabourdin, Orasri Wittawatmongkol, Daniela Garone, S. El-Hadj Djibril, S. Duda, C. Twizere, K. C. Chan, Annie J. Sasco, N. Sanmeema, N. V. Lam, J. Conrad, Q. T. Du, P. Tharnprisan, Z. Yao, A. Djeha, Siriatou A. Koumakpai, Joachim Gnokoro, I. Hodonou, Sabine Hermans, Timothy R. Sterling, C. Nchot, D. Minta, E. Yunihastuti, T. F. Eboua, T. Cissé, Revathy Nallusamy, Jeffrey S. A. Stringer, Dabis F, F. Bohossou, Brian Eley, E. Traore, R. McKaig, Matthew Law, Manhattan Charurat, G. M. Kouakou, Madeleine Amorissani Folquet, A. Mandalakas, Sophie Desmonde, S. Eholié, J. K. Assouan, Andrew Boulle, Tuti Parwati Merati, A. Koko Lawson-Evi, Eugene Mutimura, C. A. Bosse, M Dosso, Fred Nalugoda, T. T. Pham, T. Udomphanit, H. L. Ha, N. Kancheya, N. Han, J. Sehonou, S. N. Kangah, R. Huebner, A. Gasser, C. Gilbert, Appolinaire Horo, J. C. Kouakou, D. Yé, P. Acquah, A. Héma, Pope Kosalaraksa, Hans Prozesky, J. James, Fatoumata Dicko, P. Cahn, Moussa Doumbia, I. Oliviera-Souto, Morna Cornell, Elenore Judy B. Uy, G. Hounhoui, J. E. Carter, V. A. Yao, Adrien Sawadogo, B. Petersen, S. E. Reid, B. Goka, G. Carriquiry, M. A. Davies, P. Nipathakosol, J. Le Carrou, M. L. Lindegren, H. Dior, P. Cegielski, E. Baramperanye, Mariam Sylla, Anders Fomsgaard, P. Braitstein, S. T. Coulibaly, D. D. Cuong, C. N'Diaye, M. Kone, Dewa Nyoman Wirawan, A. Gitembagara, Niaboula Koné, K. Ruxrungtham, R. Bognounou, Aissatou Touré, A. Ephoévi-gah, Alex Lund Laursen, and Y. Atakouma

Subjects
Male, Questionnaires, West African, Pediatrics, Asia Pacific, Antitubercular Agents, HIV Infections, Drug resistance, rifampicin, South Africa, drug resistant tuberculosis, Surveys and Questionnaires, Tuberculosis, Multidrug-Resistant, Central Africa, antiretrovirus agent, Human immunodeficiency virus infected patient, clinical practice, microbial sensitivity test, Infectious Diseases, priority journal, urban population, Female, anti human immunodeficiency virus agent, supply and distribution, medicine.drug, Pulmonary and Respiratory Medicine, Adult, isoniazid, medicine.medical_specialty, Tuberculosis, Asia, phenotype, Anti-HIV Agents, Developing country, MDR-TB, Microbial Sensitivity Tests, purl.org/pe-repo/ocde/ford#3.03.08 [https], preventive medicine, Article, South and Central America, socioeconomics, medicine, Humans, controlled study, human, rural population, drug sensitivity, Developing Countries, Directly Observed Therapy, Preventive healthcare, ART programs, Caribbean, business.industry, questionnaire, Drug resistant tuberculosis, developing country, CD4 lymphocyte count, Central africa, Central America, South America, medicine.disease, major clinical study, Latin America, purl.org/pe-repo/ocde/ford#3.02.07 [https], Africa, world health organization, tuberculostatic agent, business, Rifampicin
Abstract

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Published
2014

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