28 results on '"Enos, Masini"'
Search Results
2. Accuracy of computer-aided chest X-ray in community-based tuberculosis screening: Lessons from the 2016 Kenya National Tuberculosis Prevalence Survey.
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Brenda Mungai, Jane Ong'angò, Chu Chang Ku, Marc Y R Henrion, Ben Morton, Elizabeth Joekes, Elizabeth Onyango, Richard Kiplimo, Dickson Kirathe, Enos Masini, Joseph Sitienei, Veronica Manduku, Beatrice Mugi, Stephen Bertel Squire, Peter MacPherson, and IMPALA Consortium
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Public aspects of medicine ,RA1-1270 - Abstract
Community-based screening for tuberculosis (TB) could improve detection but is resource intensive. We set out to evaluate the accuracy of computer-aided TB screening using digital chest X-ray (CXR) to determine if this approach met target product profiles (TPP) for community-based screening. CXR images from participants in the 2016 Kenya National TB Prevalence Survey were evaluated using CAD4TBv6 (Delft Imaging), giving a probabilistic score for pulmonary TB ranging from 0 (low probability) to 99 (high probability). We constructed a Bayesian latent class model to estimate the accuracy of CAD4TBv6 screening compared to bacteriologically-confirmed TB across CAD4TBv6 threshold cut-offs, incorporating data on Clinical Officer CXR interpretation, participant demographics (age, sex, TB symptoms, previous TB history), and sputum results. We compared model-estimated sensitivity and specificity of CAD4TBv6 to optimum and minimum TPPs. Of 63,050 prevalence survey participants, 61,848 (98%) had analysable CXR images, and 8,966 (14.5%) underwent sputum bacteriological testing; 298 had bacteriologically-confirmed pulmonary TB. Median CAD4TBv6 scores for participants with bacteriologically-confirmed TB were significantly higher (72, IQR: 58-82.75) compared to participants with bacteriologically-negative sputum results (49, IQR: 44-57, p
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- 2022
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3. Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya
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Enos Masini, James A Amisi, and E Jane Carter
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Medicine - Abstract
Setting Children especially those
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- 2021
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4. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis
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Lucia Cilloni, Han Fu, Juan F Vesga, David Dowdy, Carel Pretorius, Sevim Ahmedov, Sreenivas A. Nair, Andrei Mosneaga, Enos Masini, Suvanand Sahu, and Nimalan Arinaminpathy
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Tuberculosis ,Covid-19 ,Epidemiology ,Mathematical modellingabstract ,Medicine (General) ,R5-920 - Abstract
Background: Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated. Methods: We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact. Findings: Even temporary disruptions can cause long-term increases in TB incidence and mortality. If lockdown-related disruptions cause a temporary 50% reduction in TB transmission, we estimated that a 3-month suspension of TB services, followed by 10 months to restore to normal, would cause, over the next 5 years, an additional 1⋅19 million TB cases (Crl 1⋅06–1⋅33) and 361,000 TB deaths (CrI 333–394 thousand) in India, 24,700 (16,100–44,700) TB cases and 12,500 deaths (8.8–17.8 thousand) in Kenya, and 4,350 (826–6,540) cases and 1,340 deaths (815–1,980) in Ukraine. The principal driver of these adverse impacts is the accumulation of undetected TB during a lockdown. We demonstrate how long term increases in TB burden could be averted in the short term through supplementary “catch-up” TB case detection and treatment, once restrictions are eased. Interpretation: Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with rapid restoration of TB services, and targeted interventions that are implemented as soon as restrictions are lifted. Funding: USAID and Stop TB Partnership
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- 2020
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5. Outcomes of isoniazid preventive therapy among people living with HIV in Kenya: A retrospective study of routine health care data.
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Muthoni Karanja, Leonard Kingwara, Philip Owiti, Elvis Kirui, Faith Ngari, Richard Kiplimo, Maurice Maina, Enos Masini, Elizabeth Onyango, and Catherine Ngugi
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Medicine ,Science - Abstract
IntroductionIsoniazid preventive therapy (IPT) taken by People Living with HIV (PLHIV) protects against active tuberculosis (TB). Despite its recommendation, data is scarce on the uptake of IPT among PLHIV and factors associated with treatment outcomes. We aimed at determining the proportion of PLHIV initiated on IPT, assessed TB screening practices during and after IPT and IPT treatment outcomes.MethodsA retrospective cohort study of a representative sample of PLHIV initiated on IPT between July 2015 and June 2018 in Kenya. For PLHIV initiated on IPT during the study period, we abstracted patient IPT uptake data from the National data warehouse. In contrast, we obtained information on socio-demographic, TB screening practices, IPT initiation, follow up, and outcomes from health facilities' patient record cards, IPT cards, and IPT registers. Further, we assessed baseline characteristics as potential correlates of developing active TB during and after treatment and IPT completion using multivariable logistic regression.ResultsFrom the data warehouse, 138,442 PLHIV were enrolled into ART during the study period and initiated 95,431 (68.9%) into IPT. We abstracted 4708 patients' files initiated on IPT, out of which 3891(82.6%) had IPT treatment outcomes documented, 4356(92.5%) had ever screened for TB at every clinic visit, and 4,243(90.1%) had documentation of TB screening on the IPT tool before IPT initiation. 3712(95.4%) of patients with documented IPT treatment outcomes completed their treatment. 42(0.89%) of the abstracted patients developed active TB,16(38.1%) during, and 26(61.9%) after completing IPT. Follow up for active TB at 6-month post-IPT completion was done for 2729(73.5%) of patients with IPT treatment outcomes. Sex, Viral load suppression, and clinic type were associated with TB development (pConclusionIPT initiation stands at two-thirds of the PLHIV, with a high completion rate. TB screening practices were better during IPT than after completion. Development of active TB during and after IPT emphasizes the need for a keen follow up.
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- 2020
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6. Gender difference in mortality among pulmonary tuberculosis HIV co-infected adults aged 15-49 years in Kenya.
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Rose J Kosgei, Steven Callens, Peter Gichangi, Marleen Temmerman, Anne-Beatrice Kihara, Gathara David, Eunice Nyaboe Omesa, Enos Masini, and E Jane Carter
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Medicine ,Science - Abstract
SettingKenya, 2012-2015.ObjectiveTo explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya.DesignRetrospective cohort of 9,026 smear-positive patients aged 15-49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count.ResultsOf the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, respectively. Overall, out of the 9,026 patients, 8,154 (90%) had their treatment outcome as cured, the mean age in years (SD) was 33.3(7.5) and the mean body mass index (SD) was 18.2(3.4). Men were older (30% men' vs 17% women in those ≥40 years, p = ConclusionWomen with sputum positive PTB/HIV co-infection have a significantly lower risk of all-cause mortality during TB treatment compared to men. Men were older, had lower BMI and tested later for HIV than women.
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- 2020
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7. Assessing tuberculosis control priorities in high-burden settings: a modelling approach
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Juan F Vesga, PhD, Timothy B Hallett, ProfPhD, Michael J A Reid, MD, Kuldeep Singh Sachdeva, MBA, Raghuram Rao, DPH, Sunil Khaparde, PhD, Paresh Dave, MPH, Kiran Rade, MD, Maureen Kamene, MSc, Eunice Omesa, MSc, Enos Masini, MPH, Newton Omale, MSc, Elizabeth Onyango, MSc, Philip Owiti, MSc, Muthoni Karanja, MSc, Richard Kiplimo, MSc, Sofia Alexandru, MPH, Valentina Vilc, MPH, Valeriu Crudu, PhD, Stela Bivol, MPH, Cristina Celan, MPH, and Nimalan Arinaminpathy, DPhil
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Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: In the context of WHO's End TB strategy, there is a need to focus future control efforts on those interventions and innovations that would be most effective in accelerating declines in tuberculosis burden. Using a modelling approach to link the tuberculosis care cascade to transmission, we aimed to identify which improvements in the cascade would yield the greatest effect on incidence and mortality. Methods: We engaged with national tuberculosis programmes in three country settings (India, Kenya, and Moldova) as illustrative examples of settings with a large private sector (India), a high HIV burden (Kenya), and a high burden of multidrug resistance (Moldova). We collated WHO country burden estimates, routine surveillance data, and tuberculosis prevalence surveys from 2011 (for India) and 2016 (for Kenya). Linking the tuberculosis care cascade to tuberculosis transmission using a mathematical model with Bayesian melding in each setting, we examined which cascade shortfalls would have the greatest effect on incidence and mortality, and how the cascade could be used to monitor future control efforts. Findings: Modelling suggests that combined measures to strengthen the care cascade could reduce cumulative tuberculosis incidence by 38% (95% Bayesian credible intervals 27–43) in India, 31% (25–41) in Kenya, and 27% (17–41) in Moldova between 2018 and 2035. For both incidence and mortality, modelling suggests that the most important cascade losses are the proportion of patients visiting the private health-care sector in India, missed diagnosis in health-care settings in Kenya, and drug sensitivity testing in Moldova. In all settings, the most influential delay is the interval before a patient's first presentation for care. In future interventions, the proportion of individuals with tuberculosis who are on high-quality treatment could offer a more robust monitoring tool than routine notifications of tuberculosis. Interpretation: Linked to transmission, the care cascade can be valuable, not only for improving patient outcomes but also in identifying and monitoring programmatic priorities to reduce tuberculosis incidence and mortality. Funding: US Agency for International Development, Stop TB Partnership, UK Medical Research Council, and Department for International Development.
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- 2019
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8. The spatial epidemiology of leprosy in Kenya: A retrospective study.
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Fatihiyya Wangara, Hillary Kipruto, Oscar Ngesa, James Kayima, Enos Masini, Joseph Sitienei, and Faith Ngari
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundLeprosy elimination defined as a registered prevalence rate of less than 1 case per 10,000 persons was achieved in Kenya at the national level in 1989. However, there are still pockets of leprosy in some counties where late diagnosis and consequent physical disability persist. The epidemiology of leprosy in Kenya for the period 2012 through to 2015 was defined using spatial methods.MethodsThis was a retrospective ecological correlational study that utilized leprosy case based data extracted from the National Leprosy Control Program database. Geographic information system and demographic data were obtained from Kenya National Bureau of Statistics (KNBS). Chi square tests were carried out to check for association between sociodemographic factors and disease indicators. Two Spatial Poisson Conditional Autoregressive (CAR) models were fitted in WinBUGS 1.4 software. The first model included all leprosy cases (new, retreatment, transfers from another health facility) and the second one included only new leprosy cases. These models were used to estimate leprosy relative risks per county as compared to the whole country i.e. the risk of presenting with leprosy given the geographical location.Principal findingsChildren aged less than 15 years accounted for 7.5% of all leprosy cases indicating active leprosy transmission in Kenya. The risk of leprosy notification increased by about 5% for every 1 year increase in age, whereas a 1% increase in the proportion of MB cases increased the chances of new leprosy case notification by 4%. When compared to the whole country, counties with the highest risk of leprosy include Kwale (relative risk of 15), Kilifi (RR;8.9) and Homabay (RR;4.1), whereas Turkana had the lowest relative risk of 0.005.ConclusionLeprosy incidence exhibits geographical variation and there is need to institute tailored local control measures in these areas to reduce the burden of disability.
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- 2019
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9. ‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey
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Enos Masini, Brenda Mungai, Dickson Kirathe, Joseph Sitienei, Elizabeth Joekes, Ben Morton, Richard Kiplimo, Veronica Manduku, Jane Rahedi Ong'ang'o, Stephen Bertel Squire, Angela Obasi, Peter MacPherson, Beatrice Mugi, and Rose Oronje
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Tuberculosis ,bronchiectasis ,Population ,wa_395 ,Disease ,030204 cardiovascular system & hematology ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Disease Screening ,Internal medicine ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Mass Screening ,030212 general & internal medicine ,education ,Tuberculosis, Pulmonary ,Retrospective Studies ,COPD ,education.field_of_study ,Bronchiectasis ,business.industry ,imaging/CT MRI etc ,Middle Aged ,medicine.disease ,Kenya ,emphysema ,Cross-Sectional Studies ,Radiological weapon ,Female ,Radiography, Thoracic ,wf_200 ,Abnormality ,business ,COPD epidemiology ,wf_225 - Abstract
BackgroundThe prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.MethodsWe reviewed a random sample of 1140 adult (≥15 years) CXRs classified as ‘abnormal, suggestive of TB’ or ‘abnormal other’ during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).
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- 2021
10. Accuracy of computer-aided chest X-ray screening in the Kenya National Tuberculosis Prevalence Survey
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Beatrice Mugi, Peter MacPherson, Marc Yr Henrion, Jane Ong‘angò, Richard Kiplimo, Ben Morton, Enos Masini, Elizabeth Joekes, Joseph Sitienei, Brenda Mungai, Elizabeth Onyango, Stephen Bertel Squire, Dickson Kirathe, Chu Chang Ku, and Veronica Manduku
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medicine.medical_specialty ,Tuberculosis ,business.industry ,Tb screening ,Community screening ,Prevalence survey ,medicine.disease ,Latent class model ,Sputum testing ,Internal medicine ,Credible interval ,medicine ,Sputum ,medicine.symptom ,business - Abstract
BackgroundCommunity-based screening for tuberculosis (TB) could improve detection but is resource intensive. We set out to evaluate the accuracy of computer-aided TB screening using digital chest X-ray (CXR) to determine if this approach met target product profiles (TPP) for community-based screening.MethodsCXR images from participants in the 2016 Kenya National TB Prevalence Survey were evaluated using CAD4TBv6 (Delft Imaging), giving a probabilistic score for pulmonary TB ranging from 0 (low probability) to 99 (high probability). We constructed a Bayesian latent class model to estimate the accuracy of CAD4TBv6 screening compared to bacteriologically-confirmed TB across CAD4TBv6 threshold cut-offs, incorporating data on Clinical Officer CXR interpretation, participant demographics (age, sex, TB symptoms, previous TB history), and sputum results. We compared model-estimated sensitivity and specificity of CAD4TBv6 to optimum and minimum TPPs.ResultsOf 63,050 prevalence survey participants, 61,848 (98%) had analysable CXR images, and 8,966 (14.5%) underwent sputum bacteriological testing; 298 had bacteriologically-confirmed pulmonary TB. Median CAD4TBv6 scores for participants with bacteriologically-confirmed TB were significantly higher (72, IQR: 58-82.75) compared to participants with bacteriologically-negative sputum results (49, IQR: 44-57, pConclusionsCAD4TBv6 met the optimal TPP for TB community screening. To optimise screening accuracy and efficiency of confirmatory sputum testing, we recommend that an adaptive approach to threshold setting is adopted based on participant characteristics.Take home messageCAD4TBv6 met the optimal WHO target product profile for a community TB screening tool. Specificity was lower in adults with previous TB and those aged 41 years or older; an adaptive approach to setting CAD thresholds will likely be required to optimize use.
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- 2021
11. Building a tuberculosis-free world
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Jeremy D. Goldhaber-Fiebert, Jason R. Andrews, Grania Brigden, Kuldeep Singh Sachdeva, Kitty van Weezenbeek, Amrita Daftary, Lea Prince, Tripti Pande, Almaz Sharman, Michelle Remme, Nandita. Venkatesan, Catharina Boehme, Chieko Ikeda, Danielle Cazabon, Enos Masini, Amy Bloom, Daniel P. Chin, Bruce D. Agins, Small Pm, Jennifer Furin, Juan F. Vesga, Aamir J. Khan, Mark Dybul, Sofia Alexandru, James A Seddon, Michael J. A. Reid, Michael Osberg, Victoria Y. Fan, Helen Cox, Valeriu Crudu, Eric Goosby, Laurie K Doepel, Nimalan Arinaminpathy, Lorrie McHugh, Dean T. Jamison, Mark Harrington, Sunil D. Khaparde, Christy L Hanson, Ellen M. H. Mitchell, Paula I Fujiwara, Timothy B. Hallett, Guy Stallworthy, Gavin Yamey, Endalkachew Fekadu, Soumya Swaminathan, Aaron Motsoaledi, Barry R. Bloom, Adithya Cattamanchi, Stela Bivol, Priya B. Shete, Nalini Krishnan, Gabriela B. Gomez, Mario C. Raviglione, Sara Fewer, Maureen Kamene, Zelalem Temesgen, Raghuram Rao, Nick Herbert, Suerie Moon, Devesh Gupta, Anthony S. Fauci, Anna Vassall, Puneet Dewan, Richard E. Chaisson, Gavin J. Churchyard, Jeremy Farrar, Valentina Vilc, Irene Koek, Madhukar Pai, Naomi Beyeler, Casey Selwyn, Kirankumar Rade, Robert W Eisinger, Lucica Ditiu, Stephen M. Graham, Philip C. Hopewell, and Eunice W Mailu
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Economic growth ,Tuberculosis ,Population ,World Health Organization/economics ,Commission ,030204 cardiovascular system & hematology ,Global Health ,World Health Organization ,Quality of Health Care/standards ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,Disease Eradication ,Mortality ,education ,Tuberculosis, Pulmonary ,Health policy ,Global Health/legislation & jurisprudence ,Quality of Health Care ,education.field_of_study ,Health Priorities ,Political Systems ,Research/economics ,Research ,Health Policy ,Incidence ,Mycobacterium tuberculosis/drug effects ,Mycobacterium tuberculosis ,General Medicine ,Private sector ,medicine.disease ,Leadership ,Accountability ,Business ,Implementation research ,Goals ,Pulmonary/drug therapy - Abstract
___Key messages___ The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer the question of how countries with high-burden tuberculosis and their development partners should target their future investments to ensure that ending tuberculosis is achievable. __Invest first to ensure that high quality rapid diagnostics and treatment are provided to all individuals receiving care for tuberculosis, wherever they seek care__ This priority includes rapid drug susceptibility testing and second-line treatment for resistant forms of tuberculosis. Achieving universal, high-quality person-centred and family-centred care—including sustained improvement in the performance of private sector providers—usually should be the top policy and budget priority. __Reach people and populations at high risk for tuberculosis (such as household and other close contacts of people with tuberculosis, and people with HIV) and bring them into care__ Active case-finding and treatment in high-risk populations demands adequate resources to reach and care for these populations. At the same time, reaching certain high-risk populations, such as people co-infected with tuberculosis and HIV, for tuberculosis preventive therapy is essential to achieve epidemiologic control. Once high-risk populations have access to affordable, high-quality diagnostic, treatment and preventive services, invest in identifying tuberculosis cases in the general population, primarily by strengthening the capacity to deliver health services and move toward universal health coverage. __Increase investment to accelerate tuberculosis research and development and bring new diagnostics, therapeutic strategies, and vaccines to clinical practice to quickly end the pandemic__ Strong advocacy with science ministries and research-oriented pharmaceutical companies is crucial, including ministries and companies in middle-income countries, to highlight the importance of investing in new tools. Financing the early uptake of new products will provide important confidence signals to product developers. __Make investment in tuberculosis programmes a shared responsibility, increasing development assistance for tuberculosis according to the financial needs of individual low-income and middle-income countries__ As countries successfully mobilise more domestic resources towards tuberculosis programmes, external assistance to middle-income countries should address the following priorities: reduce the spread of drug-resistant tuberculosis in all affected low-income and middle-income countries; facilitate market-shaping activities to enable access to high quality drugs and diagnostics for high-burden countries; and finance tuberculosis research and development, including product development as well as population, policy, and implementation research that will provide lessons and international sharing of best practices. __Hold countries and key stakeholders accountable for progress made towards ending tuberculosis__ Accountability entails establishing independent, multisectoral processes, such as national tuberculosis report cards, to ensure that all stakeholders carry out their responsibilities to contribute to ending the pandemic. Accountability mechanisms should not only assess progress, but also guarantee that Heads of Governments, national tuberculosis programmes, and even regional and site-level clinics, as well as key non-governmental organisations, take the necessary corrective actions to remove obstacles to ending tuberculosis.
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- 2019
12. Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya
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Daria Szkwarko, Enos Masini, James A Amisi, and E. Jane Carter
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Pediatrics ,medicine.medical_specialty ,Tuberculosis ,030231 tropical medicine ,Antitubercular Agents ,HIV Infections ,Disease ,paediatric infectious disease & immunisation ,03 medical and health sciences ,0302 clinical medicine ,Pulmonary tuberculosis ,Chart review ,Active tb ,parasitic diseases ,medicine ,Isoniazid ,Humans ,030212 general & internal medicine ,Child ,Tuberculosis, Pulmonary ,Retrospective Studies ,business.industry ,Disease progression ,General Medicine ,Monitoring and evaluation ,medicine.disease ,Kenya ,Preventive therapy ,tuberculosis ,Medicine ,Public Health ,business ,community child health - Abstract
SettingChildren especially those ObjectiveThis study aims to review the child contact management (CCM) cascade and present IPT outcomes across 10 clinics in western Kenya.DesignA retrospective chart review of programmatic data of a TB Reach-funded active, clinic-based CCM strategy.ResultsOf 553 child contacts screened, 231 (42%) were reported symptomatic. 74 (13%) of the child contacts were diagnosed with active TB disease. Of those eligible for IPT, 427 (90%) initiated IPT according to TB REACH project data while 249 (58%) were recorded in the IPT register with 49 (11%) recorded as a transfer to other facilities. Of the 249 recorded in the IPT register, 205 (82%) were documented to complete therapy (48% of project initiation children).ConclusionOur evaluation shows gaps in the routine CCM care cascade related to completeness of documentation that require further programmatic monitoring and evaluation to improve CCM outcomes.
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- 2021
13. Improving case detection of tuberculosis in hospitalised Kenyan children—employing the behaviour change wheel to aid intervention design and implementation
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Michael Boele van Hensbroek, Caroline Jones, Jacinta Nzinga, Jacquie Oliwa, Anja van’t Hoog, Enos Masini, Mike English, Global Health, General Paediatrics, Paediatric Infectious Diseases / Rheumatology / Immunology, AII - Infectious diseases, and APH - Global Health
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Persuasion ,Restructuring ,Health Personnel ,media_common.quotation_subject ,Psychological intervention ,Health Informatics ,Intervention ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Hospitalised ,Intervention (counseling) ,Humans ,Medicine ,Tuberculosis ,030212 general & internal medicine ,Child ,Diagnostics ,Health policy ,media_common ,Case detection ,Medical education ,business.industry ,Communication ,Research ,030503 health policy & services ,Health Policy ,1. No poverty ,Public Health, Environmental and Occupational Health ,Health services research ,Behaviour change ,General Medicine ,Kenya ,3. Good health ,Implementation ,0305 other medical science ,business ,Delivery of Health Care - Abstract
Background The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya, and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel. Methods We used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included (i) what is the problem we are trying to solve; (ii) what behaviours are we trying to change and in what way; (iii) what will it take to bring about desired change; (iv) what types of interventions are likely to bring about desired change; (v) what should be the specific intervention content and how should this be implemented? Results The following behaviour change intervention functions were identified as follows: (i) training: imparting practical skills; (ii) modelling: providing an example for people to aspire/imitate; (iii) persuasion: using communication to induce positive or negative feelings or stimulate action; (iv) environmental restructuring: changing the physical or social context; and (v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and workflow restructuring with role specification. Conclusion The intervention components were selected for their effectiveness (from literature), affordability, acceptability, and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.
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- 2020
14. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis
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Suvanand Sahu, Carel Pretorius, Han Fu, Sevim Ahmedov, Enos Masini, Andrei Mosneaga, Sreenivas Achuthan Nair, Lucia Cilloni, Juan F. Vesga, David Dowdy, and Nimalan Arinaminpathy
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medicine.medical_specialty ,Tuberculosis ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Psychological intervention ,01 natural sciences ,law.invention ,Mathematical modellingabstract ,03 medical and health sciences ,0302 clinical medicine ,law ,Environmental health ,Pandemic ,medicine ,030212 general & internal medicine ,0101 mathematics ,Potential impact ,lcsh:R5-920 ,business.industry ,Incidence (epidemiology) ,010102 general mathematics ,General Medicine ,medicine.disease ,Transmission (mechanics) ,business ,Covid-19 ,lcsh:Medicine (General) ,Research Paper - Abstract
Background Routine services for tuberculosis (TB) are being disrupted by stringent lockdowns against the novel SARS-CoV-2 virus. We sought to estimate the potential long-term epidemiological impact of such disruptions on TB burden in high-burden countries, and how this negative impact could be mitigated. Methods We adapted mathematical models of TB transmission in three high-burden countries (India, Kenya and Ukraine) to incorporate lockdown-associated disruptions in the TB care cascade. The anticipated level of disruption reflected consensus from a rapid expert consultation. We modelled the impact of these disruptions on TB incidence and mortality over the next five years, and also considered potential interventions to curtail this impact. Findings Even temporary disruptions can cause long-term increases in TB incidence and mortality. If lockdown-related disruptions cause a temporary 50% reduction in TB transmission, we estimated that a 3-month suspension of TB services, followed by 10 months to restore to normal, would cause, over the next 5 years, an additional 1⋅19 million TB cases (Crl 1⋅06–1⋅33) and 361,000 TB deaths (CrI 333–394 thousand) in India, 24,700 (16,100–44,700) TB cases and 12,500 deaths (8.8–17.8 thousand) in Kenya, and 4,350 (826–6,540) cases and 1,340 deaths (815–1,980) in Ukraine. The principal driver of these adverse impacts is the accumulation of undetected TB during a lockdown. We demonstrate how long term increases in TB burden could be averted in the short term through supplementary “catch-up” TB case detection and treatment, once restrictions are eased. Interpretation Lockdown-related disruptions can cause long-lasting increases in TB burden, but these negative effects can be mitigated with rapid restoration of TB services, and targeted interventions that are implemented as soon as restrictions are lifted. Funding USAID and Stop TB Partnership
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- 2020
15. Its not TB but what could it be? Abnormalities on chest X-rays taken during the Kenya National Tuberculosis Prevalence Survey
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Ben Morton, Joseph Sitienei, S. B. Squire, Angela Obasi, Peter MacPherson, Dickson Kirathe, Veronica Manduku, Enos Masini, Jane Rahedi Ong'ang'o, Rose N. Oronje, Richard Kiplimo, Elizabeth Joekes, Beatrice Mugi, and Brenda Mungai
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education.field_of_study ,medicine.medical_specialty ,Bronchiectasis ,Tuberculosis ,medicine.diagnostic_test ,business.industry ,Population ,Context (language use) ,Disease ,medicine.disease ,Disease Screening ,Internal medicine ,Medicine ,business ,education ,Chest radiograph ,Mass screening - Abstract
Background The prevalence of diseases other than tuberculosis (TB) detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to quantify and characterise non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB prevalence survey. Methods We reviewed a random sample of 1140 adult (≥15 years) CXRs classified as “abnormal, suggestive of TB” or “abnormal other” during field interpretation from the TB Prevalence Survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological diagnosis. A third reader resolved discrepancies. Prevalence and 95% confidence intervals of abnormalities diagnosis were estimated. Findings Cardiomegaly was the most common non-TB abnormality at 259/1123 (23.1%, 95% CI 20.6%-25.6%), while cardiomegaly with features of cardiac failure occurred in 17/1123 (1.5 %, 95% CI 0.9%-2.4%). We also identified chronic pulmonary pathology including suspected chronic obstructive pulmonary disease in 3.2% (95% CI 2.3%-4.4%) and non-specific patterns in 4.6% (95% CI 3.5%-6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6%-4.8%) and 1.4% (95% CI 0.8%-2.3%) respectively. Interpretation Based on radiological diagnosis, we identified a wide variety of non-TB diagnoses during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts. Funding National Institute for Health Research (IMPALA-grant reference 16/136/35). Evidence before this study Tuberculosis (TB) remains the leading adult infectious killer in the world. The World Health Organization (WHO) recommends the use of chest X-ray (CXR) as a mass screening tool in TB prevalence surveys and active case finding activities to identify patients eligible for bacteriological investigation. Mathematical modelling suggests that an algorithm incorporating a screening CXR to direct subsequent Xpert MTB/RIF testing is the optimal pathway with lowest number needed to test at acceptable programme costs in active case finding mass screening activities. Increased digital X-ray availability, coupled with the development of Computer Aided Detection (CAD) software for identification of TB, could enable widespread use of CXR in screening for TB in areas with limited access to radiologists. In addition, CXR has an advantage of detecting conditions besides TB. However, the prevalence of diseases other than TB identified by CXR during TB mass screening or TB prevalence survey activities is unknown. We systematically searched MEDLINE, CINHAL, Global Health and Google scholar databases from 1940–2019 to identify studies that described the prevalence of non-TB CXR findings during TB prevalence surveys or mass screening activities. The WHO Stop TB Department website and reference lists from relevant reviews and studies were used to supplement the search. The search strategy included MESH terms: “Chest Xray” or “Chest-Xray” or “Chest radiograph” or “Mass screening” or “Mass radiography” AND “Tuberculosis screening” or “Tuberculosis triaging” or “TB screening” or “TB triaging” AND “Non-tuberculous” or “Non-TB pathology” or “other pathology”. Our search yielded a number of studies using CXR screening in prevalence surveys as well as active case finding activities. However, studies describing non-TB pathology during mass radiography were few and mostly in the 20th century. A report in Europe between 1946 and 1948 documented 35% non-TB pathology on mass miniature X-rays. Our search did not identify any evidence pertinent to the sub-Saharan African context. Added value of this study In this cross-sectional study, we analysed individual-level participant CXR data from the 2016 Kenya National TB Prevalence Survey. Our aim was to quantify and characterise non-TB abnormalities identified by TB-focused CXR screening during the survey. We hypothesised that non-TB abnormalities requiring further clinical review are highly prevalent and need to be considered when implementing CXR screening for TB. Our study identified multiple non-TB diagnoses. The most prevalent was cardiomegaly at 23.1% (95% CI 20.6%-25.6%). We also identified chronic pulmonary pathology including suspected chronic obstructive pulmonary disease (COPD) and non-specific interstitial patterns. Mediastinal masses, excluding goitres, occurred in 0.8% (95% CI 0.4%-1.5%). TB related abnormalities, which may cause chronic respiratory symptoms, such as severe bronchiectasis and/or destroyed lung were present in 1.4%(95% CI 0.8%-2.3%). Median CAD4TB scores were low for the non-TB abnormalities. Implications of all the available evidence Our study demonstrated a high prevalence of CXR-identified non-TB abnormalities, including cardiomegaly, chronic pulmonary diseases, post-TB lung disease and non-specific lung diseases. Implementation of CXR TB screening in this context requires detailed health system planning to incorporate provision of care to people with non-TB abnormalities. This could include incorporation of additional tests such as blood pressure monitoring and spirometry as part of community TB screening interventions.
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- 2020
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16. Tuberculosis preventive therapy uptake barriers: what are the low-lying fruits to surmount this?
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E. Wandwalo, Brenda Mungai, and Enos Masini
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medicine.medical_specialty ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,wa_108 ,wa_395 ,Tuberculosis preventive therapy ,wf_205_1 ,Editorial ,medicine ,wf_200 ,Intensive care medicine ,business ,Lying - Published
- 2020
17. Gender difference in mortality among pulmonary tuberculosis HIV co-infected adults aged 15-49 years in Kenya
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Anne-Beatrice Kihara, Enos Masini, Gathara David, Eunice Omesa, E. Jane Carter, Steven Callens, Peter Gichangi, Marleen Temmerman, and Rose J. Kosgei
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Male ,Bacterial Diseases ,RNA viruses ,Physiology ,Epidemiology ,HIV Infections ,Pathology and Laboratory Medicine ,Medical Conditions ,Immunodeficiency Viruses ,Medicine and Health Sciences ,EPIDEMIOLOGY ,Public and Occupational Health ,Virus Testing ,RISK ,Multidisciplinary ,Coinfection ,Middle Aged ,MALNUTRITION ,Vaccination and Immunization ,Body Fluids ,Infectious Diseases ,Medical Microbiology ,HIV epidemiology ,Viral Pathogens ,Viruses ,Medicine ,Female ,medicine.symptom ,Pathogens ,Anatomy ,Research Article ,Adult ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,TRANSMISSION ,Science ,Immunology ,Antiretroviral Therapy ,Lower risk ,Microbiology ,Sex Factors ,Antiviral Therapy ,Pulmonary tuberculosis ,Diagnostic Medicine ,Internal medicine ,Retroviruses ,medicine ,Humans ,Mortality ,Tuberculosis, Pulmonary ,Microbial Pathogens ,business.industry ,Lentivirus ,Organisms ,Sputum ,Biology and Life Sciences ,HIV ,Retrospective cohort study ,medicine.disease ,Tropical Diseases ,Kenya ,Malnutrition ,Mucus ,Age Groups ,Medical Risk Factors ,People and Places ,Population Groupings ,Preventive Medicine ,TREATMENT OUTCOMES ,business ,Body mass index - Abstract
Setting Kenya, 2012–2015 Objective To explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya. Design Retrospective cohort of 9,026 smear-positive patients aged 15–49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count. Results Of the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, respectively. Overall, out of the 9,026 patients, 8,154 (90%) had their treatment outcome as cured, the mean age in years (SD) was 33.3(7.5) and the mean body mass index (SD) was 18.2(3.4). Men were older (30% men’ vs 17% women in those ≥40 years, p = Conclusion Women with sputum positive PTB/HIV co-infection have a significantly lower risk of all-cause mortality during TB treatment compared to men. Men were older, had lower BMI and tested later for HIV than women.
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- 2020
18. Epidemiology of Pediatric Tuberculosis in Kenya and Risk Factors for Mortality during Treatment: A National Retrospective Cohort Study
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Enos Masini, Courtney M. Yuen, Dickens Onyango, and Martien W. Borgdorff
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Male ,Kenya ,medicine.medical_specialty ,Adolescent ,Human immunodeficiency virus (HIV) ,Psychological intervention ,HIV Infections ,medicine.disease_cause ,Cohort Studies ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,Internal medicine ,Epidemiology ,medicine ,Humans ,Tuberculosis ,030212 general & internal medicine ,Child ,Survival analysis ,Retrospective Studies ,Coinfection ,Hospitals, Public ,business.industry ,Hazard ratio ,Age Factors ,Infant, Newborn ,Infant ,Retrospective cohort study ,Pediatric tuberculosis ,Anti-Retroviral Agents ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Objectives To describe the epidemiology of childhood tuberculosis (TB) in Kenya, assess the magnitude of TB/human immunodeficiency virus (HIV) co-infection and identify risk factors for mortality during TB treatment. Study design We conducted a retrospective analysis of the Kenyan national TB program data for patients enrolled from 2013 through 2015. A total of 23 753 children aged less than 15 years were included in the analysis. Survival analysis was performed with censorship at 9 months and mortality was the main outcome. We used Cox proportional hazards regression for assessing risk factors for mortality. Results Childhood TB accounted for 9% (n = 24 216) of all patients with TB; 98% of the notified children (n = 23 753) were included in the analysis. TB/HIV co-infection was 28% (n = 6112). Most TB cases (71%; n = 16 969) were detected through self-referral. Treatment was successful in 90% (n = 19 088) and 4% (n = 1058) died. Independent risk factors for mortality included being HIV infected but not on antiretroviral therapy (adjusted hazard ratio [aHR], 4.84; 95% CI, 3.59-6.51), being HIV infected and on antiretroviral therapy (aHR, 3.69; 95% CI, 3.14-4.35), children aged less than 5 years (aHR, 1.25; 95% CI, 1.08-1.44), and being diagnosed with smear negative pulmonary disease (aHR, 1.68; 95% CI, 1.27-2.24). Conclusions Most childhood TB cases in Kenya were detected through passive case finding. TB/HIV co-infection is high among children on treatment for TB, and HIV is associated with an increased risk of death. There is a need to intensify active case finding among children. TB prevention interventions among HIV-infected children, early diagnosis of HIV, and early antiretroviral therapy initiation among children on TB treatment should be strengthened.
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- 2018
19. Impact of a national nutritional support programme on loss to follow-up after tuberculosis diagnosis in Kenya
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M M Githiomi, Christy Hanson, Omar Mansour, M Kamene, Enos Masini, and B-S J Kim
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Adult ,Male ,0301 basic medicine ,Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Antitubercular Agents ,MEDLINE ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Tuberculosis diagnosis ,Risk Factors ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Lost to follow-up ,Young adult ,Retrospective Studies ,030109 nutrition & dietetics ,Nutritional Support ,business.industry ,Malnutrition ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Kenya ,Treatment Outcome ,Infectious Diseases ,Female ,Lost to Follow-Up ,Electronic data ,business ,Follow-Up Studies ,Cohort study - Abstract
Setting Undernourishment is prevalent among tuberculosis (TB) patients. Nutritional support is given to TB patients to prevent and treat undernourishment; it is also used to improve treatment outcomes and as an incentive to keep patients on treatment. Objective To determine whether nutritional support is associated with a reduction in the risk of loss to follow-up (LTFU) among TB patients in Kenya. Design This was a retrospective cohort study using national programmatic data. Records of 362 685 drug-susceptible TB patients from 2012 to 2015 were obtained from Treatment Information from Basic Unit (TIBU), a national case-based electronic data recording system. Patients who were LTFU were compared with those who completed treatment. Results Nutrition counselling was associated with an 8% reduction in the risk of LTFU (RR 0.92, 95%CI 0.89-0.95), vitamins were associated with a 7% reduction (adjusted RR [aRR] 0.93, 95%CI 0.90-0.96) and food support was associated with a 10% reduction (aRR 0.90, 95%CI 0.87-0.94). Among patients who received food support, the addition of nutrition counselling was associated with a 23% reduction in the risk of LTFU (aRR 0.77, 95%CI 0.67-0.88). Conclusion Nutritional support was associated with a reduction in the risk of LTFU. Providing nutrition counselling is important for patients receiving food support.
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- 2018
20. Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin
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Adrian Gardner, Anthony D. Harries, Fatma Some, C Wambugu, N. K. Kirui, G Kasera, R Momanyi, P. Owiti, Alfred Keter, Sonak D. Pastakia, and Enos Masini
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medicine.medical_specialty ,Tuberculosis ,business.industry ,Health Policy ,030231 tropical medicine ,Public Health, Environmental and Occupational Health ,Original Articles ,medicine.disease ,Obesity ,Number needed to screen ,03 medical and health sciences ,0302 clinical medicine ,Pre diabetes ,Diabetes mellitus ,Internal medicine ,parasitic diseases ,medicine ,030212 general & internal medicine ,Family history ,business ,Glycated haemoglobin ,Point of care - Abstract
Setting: The tuberculosis (TB) clinics of five health facilities in western Kenya. Objective: To assess the prevalence and associated determinants of diabetes mellitus (DM) and pre-diabetes hyperglycaemia among adult TB patients using point-of-care DCA Vantage glycated haemoglobin (HbA1c) devices. Design: This was a cross-sectional study. Results: Of 454 patients, 272 (60%) were males, the median age was 34 years, 175 (39%) were co-infected with the human immunodeficiency virus (HIV), and the median duration of anti-tuberculosis treatment was 8 weeks; 180 (40%) patients reported at least one classical symptom suggestive of DM. The prevalence of DM (HbA1c ⩾6.5%) was 5.1% (95%CI 3.2-7.5), while that of pre-diabetes (HbA1c 5.7-6.4%) was 37.5% (95%CI 33.1-42.2). The number needed to screen (NNS) was 19.6 for DM and 2.7 for pre-diabetes. Combined, 42.6% (95%CI 38.0-47.3) of the patients had either pre-diabetes or DM (NNS 2.3). Seven of the 23 patients with DM knew their prior DM status. Higher rates of DM were associated with age ⩾40 years and a family history of DM, but not obesity, type of TB, HIV status or suggestive symptoms. Conclusions: High rates of pre-diabetes and DM were found in adult TB patients. This study supports the need for routine screening of all patients with TB for DM in Kenya.
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- 2017
21. The spatial epidemiology of leprosy in Kenya: A retrospective study
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James Kayima, Faith Ngari, Oscar Ngesa, Hillary Kipruto, Fatihiyya Wangara, Joseph Sitienei, and Enos Masini
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0301 basic medicine ,Male ,Bacterial Diseases ,Physical disability ,Spatial methods ,Databases, Factual ,Epidemiology ,RC955-962 ,Prevalence ,Marine and Aquatic Sciences ,Chi Square Tests ,Geographical Locations ,0302 clinical medicine ,Mathematical and Statistical Techniques ,Arctic medicine. Tropical medicine ,Medicine and Health Sciences ,Public and Occupational Health ,Poisson Distribution ,Child ,Aged, 80 and over ,Incidence ,Statistics ,Spatial epidemiology ,Middle Aged ,Infectious Diseases ,Late diagnosis ,Child, Preschool ,Population Surveillance ,Physical Sciences ,Epidemiology of leprosy ,Female ,Leprosy ,Public aspects of medicine ,RA1-1270 ,Research Article ,Neglected Tropical Diseases ,Freshwater Environments ,Adult ,Adolescent ,030231 tropical medicine ,Research and Analysis Methods ,03 medical and health sciences ,Young Adult ,Age Distribution ,medicine ,Humans ,Tuberculosis ,Sex Distribution ,Statistical Methods ,Disease Notification ,Statistical Hypothesis Testing ,Aged ,Retrospective Studies ,Spatial Analysis ,Chi-Square Distribution ,business.industry ,Ecology and Environmental Sciences ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Infant ,Aquatic Environments ,Retrospective cohort study ,Bodies of Water ,medicine.disease ,Tropical Diseases ,Kenya ,Health Care ,Lakes ,030104 developmental biology ,Health Care Facilities ,Medical Risk Factors ,People and Places ,Africa ,Earth Sciences ,business ,Mathematics ,Demography - Abstract
Background Leprosy elimination defined as a registered prevalence rate of less than 1 case per 10,000 persons was achieved in Kenya at the national level in 1989. However, there are still pockets of leprosy in some counties where late diagnosis and consequent physical disability persist. The epidemiology of leprosy in Kenya for the period 2012 through to 2015 was defined using spatial methods. Methods This was a retrospective ecological correlational study that utilized leprosy case based data extracted from the National Leprosy Control Program database. Geographic information system and demographic data were obtained from Kenya National Bureau of Statistics (KNBS). Chi square tests were carried out to check for association between sociodemographic factors and disease indicators. Two Spatial Poisson Conditional Autoregressive (CAR) models were fitted in WinBUGS 1.4 software. The first model included all leprosy cases (new, retreatment, transfers from another health facility) and the second one included only new leprosy cases. These models were used to estimate leprosy relative risks per county as compared to the whole country i.e. the risk of presenting with leprosy given the geographical location. Principal findings Children aged less than 15 years accounted for 7.5% of all leprosy cases indicating active leprosy transmission in Kenya. The risk of leprosy notification increased by about 5% for every 1 year increase in age, whereas a 1% increase in the proportion of MB cases increased the chances of new leprosy case notification by 4%. When compared to the whole country, counties with the highest risk of leprosy include Kwale (relative risk of 15), Kilifi (RR;8.9) and Homabay (RR;4.1), whereas Turkana had the lowest relative risk of 0.005. Conclusion Leprosy incidence exhibits geographical variation and there is need to institute tailored local control measures in these areas to reduce the burden of disability., Author summary Leprosy is a chronic bacterial disease that mainly affects the nerves. If untreated, it may cause progressive and permanent damage to the skin, nerves, limbs, and eyes leading to physical disability. Through use of a combination of drugs, Kenya was able to declare the disease as eliminated in the year 1989. However, there are still pockets of leprosy in some Kenyan counties where physical disability persists, mainly due to late diagnosis. To be able to curb this disease, control measures must be intensified, especially in the counties reporting more cases. We used data of the leprosy cases reported in Kenya for the period 2012 through to 2015 in order to describe geographical variation and factors influencing this variation. More than half of the registered cases had visible physical disability. The risk of leprosy notification increased with an increase in age as well as the severity of disease. We estimated that people living in Kwale, Kilifi and Homabay counties are 15, 9, and 5 times respectively more at risk of leprosy as compared to the whole country. Given the limited resources, it’s therefore paramount that high risk counties be initially targeted for control, with a focus on early diagnosis.
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- 2018
22. Assessing tuberculosis control priorities in high-burden settings: a modelling approach
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Sofia Alexandru, Enos Masini, Elizabeth Onyango, Sunil D. Khaparde, Maureen Kamene, Newton Omale, Timothy B. Hallett, Stela Bivol, Cristina Celan, Kiran Rade, Eunice Omesa, Paresh Dave, Michael J. A. Reid, Juan F. Vesga, Raghuram Rao, Kuldeep Singh Sachdeva, Philip Owiti, Richard Kiplimo, Valentina Vilc, Muthoni Karanja, Valeriu Crudu, Nimalan Arinaminpathy, United Nations Office for Project Services, and Medical Research Council (MRC)
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COUNTRIES ,Tuberculosis ,030231 tropical medicine ,Psychological intervention ,MEDLINE ,India ,Context (language use) ,CHINA ,law.invention ,1117 Public Health and Health Services ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,law ,TARGETS ,Environmental health ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Tuberculosis, Pulmonary ,Public, Environmental & Occupational Health ,Science & Technology ,COUGH ,Models, Statistical ,business.industry ,Health Priorities ,Incidence (epidemiology) ,lcsh:Public aspects of medicine ,DRUG-RESISTANT TUBERCULOSIS ,lcsh:RA1-1270 ,Bayes Theorem ,General Medicine ,HIV CARE ,Moldova ,Private sector ,medicine.disease ,SOUTH-AFRICA ,Kenya ,Transmission (mechanics) ,PROSPECTS ,Population Surveillance ,business ,International development ,Life Sciences & Biomedicine ,0605 Microbiology - Abstract
Summary Background In the context of WHO's End TB strategy, there is a need to focus future control efforts on those interventions and innovations that would be most effective in accelerating declines in tuberculosis burden. Using a modelling approach to link the tuberculosis care cascade to transmission, we aimed to identify which improvements in the cascade would yield the greatest effect on incidence and mortality. Methods We engaged with national tuberculosis programmes in three country settings (India, Kenya, and Moldova) as illustrative examples of settings with a large private sector (India), a high HIV burden (Kenya), and a high burden of multidrug resistance (Moldova). We collated WHO country burden estimates, routine surveillance data, and tuberculosis prevalence surveys from 2011 (for India) and 2016 (for Kenya). Linking the tuberculosis care cascade to tuberculosis transmission using a mathematical model with Bayesian melding in each setting, we examined which cascade shortfalls would have the greatest effect on incidence and mortality, and how the cascade could be used to monitor future control efforts. Findings Modelling suggests that combined measures to strengthen the care cascade could reduce cumulative tuberculosis incidence by 38% (95% Bayesian credible intervals 27–43) in India, 31% (25–41) in Kenya, and 27% (17–41) in Moldova between 2018 and 2035. For both incidence and mortality, modelling suggests that the most important cascade losses are the proportion of patients visiting the private health-care sector in India, missed diagnosis in health-care settings in Kenya, and drug sensitivity testing in Moldova. In all settings, the most influential delay is the interval before a patient's first presentation for care. In future interventions, the proportion of individuals with tuberculosis who are on high-quality treatment could offer a more robust monitoring tool than routine notifications of tuberculosis. Interpretation Linked to transmission, the care cascade can be valuable, not only for improving patient outcomes but also in identifying and monitoring programmatic priorities to reduce tuberculosis incidence and mortality. Funding US Agency for International Development, Stop TB Partnership, UK Medical Research Council, and Department for International Development.
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- 2018
23. Digital Health Support in Treatment for Tuberculosis
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Syon P. Bhanot, Erez Yoeli, Philip Owiti, Jon Rathauser, Enos Masini, Eunice W Mailu, David G. Rand, and Maureen K Kimenye
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Telemedicine ,Tuberculosis ,business.industry ,education ,MEDLINE ,Medication adherence ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Active tuberculosis ,Digital health ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Text messaging ,030212 general & internal medicine ,Medical emergency ,business ,psychological phenomena and processes - Abstract
Digital Support for Patients with Tuberculosis In this study in Kenya, investigators assessed interactive messaging with mobile phones to remind patients with active tuberculosis to take medication...
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- 2019
24. 4th National Anti-tuberculosis Drug Resistance Survey in Kenya
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null Joseph Sitienei, null Kamene Kimenye, null Josephine Wahogo, null Bernard Langat, null Enos Masini, null Obadiah Njuguna, null Jane Ong’ang’o, null Sophie Matu, null Jeremiah Okari, null Maurice Maina, null Margret Mburu, null Herman Weyenga, null Jane Mwangi, null Lucy Nganga, null Agnes Langat, null Abraham Katana, null Hillary Kipruto, and null Joel Kangangi
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medicine.medical_specialty ,Anti tuberculosis ,business.industry ,Internal medicine ,Medicine ,Drug resistance ,business - Published
- 2017
25. Kenya tuberculosis prevalence survey 2016: Challenges and opportunities of ending TB in Kenya
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Enos, Masini, primary, Sitienei, Joseph, additional, Ong’ang’o, Jane, additional, Mungai, Brenda, additional, Kamene, Maureen, additional, Wambugu, Jesse, additional, Kipruto, Hillary, additional, Manduku, Veronica, additional, Mburu, Josephine, additional, Nyaboke, Drusilla, additional, Ngari, Faith, additional, Omesa, Eunice, additional, Omale, Newton, additional, Mwirigi, Nkirote, additional, Okallo, Geoffrey, additional, Njoroge, Janice, additional, Githiomi, Martin, additional, Mwangi, Mike, additional, Kirathe, Dickson, additional, Kiplimo, Richard, additional, Ndombi, Amos, additional, Odeny, Lazarus, additional, Mailu, Eunice, additional, Kandie, Timothy, additional, Maina, Maurice, additional, Kasera, Kadondi, additional, Mulama, Beatrice, additional, Mugi, Beatrice, additional, and Weyenga, Herman, additional
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- 2018
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26. Outcomes of isoniazid prophylaxis among HIV-infected children attending routine HIV care in Kenya
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Enos Masini, J. Sitienei, and H. Weyeinga
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Pediatrics ,medicine.medical_specialty ,Treatment completion ,Tuberculosis ,business.industry ,Health Policy ,Isoniazid ,Public Health, Environmental and Occupational Health ,Human immunodeficiency virus (HIV) ,Articles ,Disease ,medicine.disease ,medicine.disease_cause ,Chronic cough ,Interquartile range ,Hiv infected ,parasitic diseases ,medicine ,medicine.symptom ,business ,medicine.drug - Abstract
Three human immunodeficiency virus (HIV) care clinics in Eastern Province, Kenya.To establish rates of treatment completion, loss to follow-up, adverse drug reactions, tuberculosis (TB) disease and mortality among 606 HIV-infected children during 6 months of isoniazid preventive therapy (IPT).Retrospective record review.Of 606 HIV-infected children started on IPT, 556 (91.7%) successfully completed treatment, while 20 (3.3%) completed with interruptions. Cumulatively, 30 children (4.9%) did not complete IPT: 4 (0.7%) were lost to follow-up, 4 (0.7%) discontinued because of treatment interruptions, 2 (0.3%) developed adverse drug reactions, 1 developed a chronic cough, 1 was transferred to a non-IPT facility and 18 (3%) developed TB, including 2 who eventually died. TB disease was diagnosed in a median of 3 weeks (interquartile range [IQR] 2-16) post-IPT initiation. The median CD4 cell count for those aged 1-4 years who developed TB disease was 1023 cells/mm(3) (IQR 375-1432), while for those aged 5-14 years it was 149 cells/mm(3) (IQR 16-332). Isoniazid resistance was not detected in the four culture-confirmed TB cases.The high treatment completion, low loss to follow-up rate and few adverse drug reactions affirm the feasibility of IPT provision to children in HIV care clinics.Trois dispensaires de soins pour le virus de l’immunodéficience humaine (VIH) dans la Province Est du Kenya.Mettre en évidence des taux d’achèvement du traitement, de perte du suivi, de réactions indésirables, de maladie tuberculeuse et de mortalité chez 606 enfants infectés par le VIH au cours de 6 mois de traitement préventif à l’isoniazide (IPT).Revue rétrospective des dossiers.Sur 606 enfants infectés par le VIH et mis sous IPT, 556 ont réussi à compléter leur traitement (91,7%), alors que 20 (3,3%) l’ont achevé mais avec des interruptions. Au total, 30 enfants (4,9%) n’ont pas achevé le traitement : parmi ceux-ci, 4 (0,7%) ont été perdus lors du suivi, 4 (0,7%) ont interrompu le traitement, 2 (0,3%) ont rencontré des effets indésirables des médicaments, 1 une toux chronique, 1 a été transféré vers un service non-IPT et chez 18 (3%) on a vu apparaître une tuberculose (TB), incluant 2 qui sont décédés. La maladie TB a été diagnostiquée après une durée médiane de 3 semaines (limites interquartiles [IQR] 2 à 16) après l’initiation de l’IPT. Le décompte médian de cellules CD4 pour les enfants âgés de 1 à 4 ans, chez qui la TB est apparue, était de 1023 cellules/mmLe taux élevé d’achèvement du traitement et le faible taux de pertes de suivi et de réactions indésirables aux médicaments confirment la faisabilité de l’administration de l’IPT aux enfants dans les dispensaires de soins VIH.Tres consultorios de atención de la infección por el virus de la inmunodeficiencia humana (VIH) en la Provincia Oriental de Kenia.Establecer en un grupo de 606 niños infectados por el VIH las tasas de compleción del tratamiento antituberculoso, pérdida durante el seguimiento, reacciones adversas a los medicamentos, enfermedad tuberculosa y de mortalidad durante los 6 meses del tratamiento preventivo con isoniazida (IPT).Fue este un examen retrospectivo de las historias clínicas.De los 606 niños con infección por el VIH que comenzaron el IPT, 556 lo completaron con éxito (91,7%) y 20 lo completaron con interrupciones (3,3%). Según el análisis acumulado, 30 niños no completaron el tratamiento (4,9%); 4 se perdieron de vista durante el tratamiento (0,7%), 4 se excluyeron por interrupciones del tratamiento (0,7%), 2 presentaron reacciones adversas a los medicamentos (0,3%), 1 presentó tos crónica, 1 se trasladó a un centro que no suministraba el IPT, 18 contrajeron la enfermedad tuberculosa (3%) y de ellos 2 fallecieron. La mediana del lapso hasta el diagnóstico de la tuberculosis (TB) fue 3 semanas (intervalo intercuartil [IQR] 2–16) después de haber iniciado el IPT. La mediana del recuento de células CD4 en los niños que contrajeron la enfermedad del subgrupo entre 1 y 4 años de edad fue 1023 células/mmEl alta tasa de compleción del tratamiento, la baja proporción de pérdidas de vista durante el seguimiento y las escasas reacciones adversas que se observaron confirman la viabilidad de la provisión del IPT a los niños en los consultorios de atención de la infección por el VIH.
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- 2013
27. Using Survival Analysis to Identify Risk Factors for Treatment Interruption among New and Retreatment Tuberculosis Patients in Kenya
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Christy Hanson, Martin Muhingo Githiomi, Omar Mansour, Clare E. Speer, Vittorio Addona, Hillary Kipruto, Joseph Sitienei, Brenda Mungai, and Enos Masini
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Bacterial Diseases ,RNA viruses ,Male ,Multivariate analysis ,Physiology ,Antitubercular Agents ,Social Sciences ,lcsh:Medicine ,HIV Infections ,Pathology and Laboratory Medicine ,Body Mass Index ,Geographical Locations ,0302 clinical medicine ,Immunodeficiency Viruses ,Risk Factors ,Medicine and Health Sciences ,Cumulative incidence ,Public and Occupational Health ,030212 general & internal medicine ,Child ,lcsh:Science ,Aged, 80 and over ,Multidisciplinary ,030503 health policy & services ,Middle Aged ,Vaccination and Immunization ,Infectious Diseases ,Treatment Outcome ,Physiological Parameters ,Medical Microbiology ,Viral Pathogens ,Viruses ,Retreatment ,Electronic data ,Female ,Pathogens ,0305 other medical science ,Research Article ,Adult ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Immunology ,Antiretroviral Therapy ,Microbiology ,03 medical and health sciences ,Young Adult ,Antiviral Therapy ,Internal medicine ,Retroviruses ,medicine ,Humans ,Obesity ,Risk factor ,Lost to follow-up ,Microbial Pathogens ,Aged ,business.industry ,Proportional hazards model ,Lentivirus ,Body Weight ,lcsh:R ,Organisms ,Biology and Life Sciences ,HIV ,medicine.disease ,Tropical Diseases ,Kenya ,Survival Analysis ,Log-rank test ,Young Adults ,Age Groups ,Prisons ,People and Places ,Africa ,Physical therapy ,Patient Compliance ,Population Groupings ,Law and Legal Sciences ,Lost to Follow-Up ,lcsh:Q ,Preventive Medicine ,business ,Criminal Justice System - Abstract
Despite high tuberculosis (TB) treatment success rate, treatment adherence is one of the major obstacles to tuberculosis control in Kenya. Our objective was to identify patient-related factors that were associated with time to TB treatment interruption and the geographic distribution of the risk of treatment interruption by county. Data of new and retreatment patients registered in TIBU, a Kenyan national case-based electronic data recording system, between 2013 and 2014 was obtained. Kaplan-Meier curves and log rank tests were used to assess the adherence patterns. Mixed-effects Cox proportional hazards modeling was used for multivariate analysis. Records from 90,170 patients were included in the study. The cumulative incidence of treatment interruption was 4.5% for new patients, and 8.5% for retreatment patients. The risk of treatment interruption was highest during the intensive phase of treatment. Having previously been lost to follow-up was the greatest independent risk factor for treatment interruption (HR: 4.79 [3.99, 5.75]), followed by being HIV-positive not on ART (HR: 1.96 [1.70, 2.26]) and TB relapse (HR: 1.70 [1.44, 2.00]). Male and underweight patients had high risks of treatment interruption (HR: 1.46 [1.35, 1.58]; 1.11 [1.03, 1.20], respectively). High rates of treatment interruption were observed in counties in the central part of Kenya while counties in the northeast had the lowest risk of treatment interruption. A better understanding of treatment interruption risk factors is necessary to improve adherence to treatment. Interventions should focus on patients during the intensive phase, patients who have previously been lost to follow-up, and promotion of integrated TB and HIV services among public and private facilities.
- Published
- 2016
28. Reduction of HIV-associated excess mortality by antiretroviral treatment among tuberculosis patients in Kenya
- Author
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Dickens Onyango, Faith Ngari, Kevin P. Cain, Martien W. Borgdorff, Enos Masini, Courtney M. Yuen, Epidemiology and Data Science, and Infectious diseases
- Subjects
Bacterial Diseases ,RNA viruses ,Male ,Epidemiology ,lcsh:Medicine ,HIV Infections ,Pathology and Laboratory Medicine ,Geographical Locations ,0302 clinical medicine ,Immunodeficiency Viruses ,Risk Factors ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,030212 general & internal medicine ,Young adult ,lcsh:Science ,education.field_of_study ,Multidisciplinary ,Mortality rate ,Middle Aged ,Vaccination and Immunization ,Infectious Diseases ,Medical Microbiology ,HIV epidemiology ,Viral Pathogens ,Viruses ,Female ,Pathogens ,Research Article ,Adult ,medicine.medical_specialty ,Tuberculosis ,Adolescent ,Death Rates ,Anti-HIV Agents ,Immunology ,030231 tropical medicine ,Population ,Antiretroviral Therapy ,Viral diseases ,Microbiology ,Young Adult ,03 medical and health sciences ,Population Metrics ,Antiviral Therapy ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,Retroviruses ,Humans ,education ,Microbial Pathogens ,Aged ,Retrospective Studies ,Population Biology ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Biology and Life Sciences ,HIV ,Tropical Diseases ,medicine.disease ,Kenya ,Standardized mortality ratio ,Age Groups ,People and Places ,Africa ,Attributable risk ,Population Groupings ,lcsh:Q ,Preventive Medicine ,business - Abstract
Background Mortality from TB continues to be a global public health challenge. TB ranks alongside Human Immunodeficiency Virus (HIV) as the leading infectious causes of death globally. HIV is a major driver of TB related morbidity and mortality while TB is the leading cause of mortality among people living with HIV/AIDS. We sought to determine excess mortality associated with HIV and the effect of antiretroviral therapy on reducing mortality among tuberculosis patients in Kenya. Methods We conducted a retrospective analysis of Kenya national tuberculosis program data of patients enrolled from 2013 through 2014. We used direct standardization to obtain standardized mortality ratios for tuberculosis patients compared with the general population. We calculated the population attributable fraction of tuberculosis deaths due to HIV based on the standardized mortality ratio for deaths among TB patients with HIV compared to TB patients without HIV. We used Cox proportional hazards regression for assessing risk factors for mortality. Results Of 162,014 patients included in the analysis, 6% died. Mortality was 10.6 (95% CI: 10.4–10.8) times higher among TB patients than the general population; 42% of deaths were attributable to HIV infection. Patients with HIV who were not receiving ART had an over four-fold risk of death compared to patients without HIV (aHR = 4.2, 95% CI 3.9–4.6). In contrast, patients with HIV who were receiving ART had only 2.6 times the risk of death (aHR = 2.6, 95% CI 2.5–2.7). Conclusion HIV was a significant contributor to TB-associated deaths in Kenya. Mortality among HIV-infected individuals was higher among those not on ART than those on ART. Early initiation of ART among HIV infected people (a “test and treat” approach) should further reduce TB-associated deaths.
- Published
- 2017
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