How can integrated care and research assist in achieving the SDG targets for diabetes, tuberculosis and HIV/AIDS?

Integrating the management and care of communicable diseases, such as tuberculosis (TB) and human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS), and non-communicable diseases, particularly diabetes mellitus (DM), may help to achieve the ambitious health-related targets of the Sustainable Development Goals (SDG 3.3 and 3.4) by 2030. There are five important reasons to integrate. First, we need to integrate to prevent disease. In sub-Saharan Africa, in particular, HIV infection is the main driver of the TB epidemic, and antiretroviral therapy combined with isoniazid preventive therapy (IPT) can reduce TB case notification rates. In Asia, DM is another important driver of the TB epidemic, and preventing or controlling DM can reduce the risk of TB. Second, we need to integrate to diagnose cases. Between a third to a half of those living with HIV, TB or DM do not know they have the disease, and bi-directional screening, whereby TB patients are screened for HIV and DM or people living with HIV and DM are screened for TB, can help to identify these 'missing cases'. Third, we need to integrate to better treat and manage patients who have a combination of two or more of these diseases, so that treatment success and retention on treatment can be optimised. Fourth, we should integrate to ensure better infection control practices for both TB and HIV infection in health facilities and congregate settings, such as prisons. Finally, we should integrate and learn how to monitor, record and report, particularly in relation to the cascade of events implicit in the HIV/AIDS and TB 90-90-90 targets

Design of cotton ginning dryer control system

CITATION: Maradzano, I., et al. 2014. Design of cotton ginning dryer control system. In SAIIE26 Proceedings, 14–16 July 2014, Muldersdrift, South Africa.The original publication is available at http://conferences.sun.ac.za/index.php/saiieENGLISH ABSTRACT: The most important factor in preserving the quality of cotton during ginning is the fibre moisture content. At higher moisture content, cotton fibres are stronger but trash is harder to remove. Selecting ginning moisture content is a compromise between good trash removal and quality preservation. In the paper, inlet and outlet moisture content of cotton being fed into and out of the dryer are monitored at temperatures given in the dryer manual and literature. A mathematical model for drying cotton is then formulated by analysing the experimental results, cotton dryer historical records and dryer manual. The results show that there is a linear relationship between the initial moisture content, final moisture content and drying temperature. A control system integrating a Barionet controller to regulate and supply of heat to the system based on the initial moisture content is then proposed. The objective of the control system is to enable online monitoring of the dryer as well as giving early warning signs when the system is about to get out of control hencesafeguarding from overheating and avoid under-drying of cotton.AFRIKAANSE OPSOMMING: Geen opsomming beskikbaarhttp://conferences.sun.ac.za/index.php/saiie/SAIIE26/paper/view/1168Publisher's versio

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

The international community has committed to ending the tuberculosis (TB) epidemic by 2030. This will require multi-sectoral action with a focus on accelerating socio-economic development, developing and implementing new tools, and expanding health insurance coverage. Within this broad framework, National TB Programmes (NTPs) are accountable for delivering diagnostic, treatment, and preventive services. There are large gaps in the delivery of these services, and the aim of this article is to review the crucial activities and interventions that NTPs must implement in order to meet global targets and milestones that will end the TB epidemic. The key deliverables are the following: turn End TB targets and milestones into national measurable indicators to make it easier to track progress; optimize the prompt and accurate diagnosis of all types of TB; provide rapid, complete, and effective treatment to all those diagnosed with TB; implement and monitor effective infection control practices; diagnose and treat drug-resistant TB, associated HIV infection, and diabetes mellitus; design and implement active case finding strategies for high-risk groups and link them to the treatment of latent TB infection; engage with the private-for-profit sector; and empower the Central Unit of the NTP particularly in relation to data-driven supportive supervision, operational research, and sustained financing. The glaring gaps in the delivery of TB services must be remedied, and some of these gaps will require new paradigms and ways of working which include patient-centered and higher-quality services. There must also be fast-track ways of incorporating new diagnostic, treatment, and prevention tools into program activities so as to rapidly reduce TB incidence and mortality and meet the goal of ending TB by 2030

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

The international community has committed to ending the tuberculosis (TB) epidemic by 2030. This will require multi-sectoral action with a focus on accelerating socio-economic development, developing and implementing new tools, and expanding health insurance coverage. Within this broad framework, National TB Programmes (NTPs) are accountable for delivering diagnostic, treatment, and preventive services. There are large gaps in the delivery of these services, and the aim of this article is to review the crucial activities and interventions that NTPs must implement in order to meet global targets and milestones that will end the TB epidemic. The key deliverables are the following: turn End TB targets and milestones into national measurable indicators to make it easier to track progress; optimize the prompt and accurate diagnosis of all types of TB; provide rapid, complete, and effective treatment to all those diagnosed with TB; implement and monitor effective infection control practices; diagnose and treat drug-resistant TB, associated HIV infection, and diabetes mellitus; design and implement active case finding strategies for high-risk groups and link them to the treatment of latent TB infection; engage with the private-for-profit sector; and empower the Central Unit of the NTP particularly in relation to data-driven supportive supervision, operational research, and sustained financing. The glaring gaps in the delivery of TB services must be remedied, and some of these gaps will require new paradigms and ways of working which include patient-centered and higher-quality services. There must also be fast-track ways of incorporating new diagnostic, treatment, and prevention tools into program activities so as to rapidly reduce TB incidence and mortality and meet the goal of ending TB by 2030

Integrating Tuberculosis and Mental Health Services: Global Receptivity of National Tuberculosis Program Directors

Setting: A global survey of National Tuberculosis Program (NTP) directors.Objectives: To assess the perceived mental health needs of persons with tuberculosis (TB), current practices, and receptivity to integrating evidence-based mental and substance use treatment into national TB guidelines.Design: Semi-structured survey of NTP directors from 26 countries of all income levels using a standardized questionnaire.Results: Of the 26 countries, 21 were classified as high incidence and/or burden countries for TB, TB and human immunodeficiency virus coinfection, and/or drug-resistant TB. Two NTPs included routine screening for any mental disorder, four assessed alcohol or drug use, and five had standard protocols for the co-management of disorders. If effective and low-cost integrated care models were available, 17 NTP directors felt that it was highly likely, and five somewhat likely, that their NTPs would integrate mental health treatment into national TB guidelines and services. The main perceived barriers to service integration were limited capacity, not recognizing mental health as a problem, insufficient resources, and TB-related social stigma.Conclusions: NTPs currently do not address mental disorders as part of routine practice. Nevertheless, receptivity is high, which creates a ripe opportunity to integrate the management of TB and mental disorders into the policies and guidelines of NTPs worldwide

Should we consider a 'fourth 90' for tuberculosis?

The international community has committed to end the tuberculosis (TB) epidemic by 2030. To facilitate the meeting of the global incidence and mortality indicators set by the World Health Organization's End TB Strategy, the Stop TB Partnership launched the three 90-(90)-90 diagnostic and treatment targets in 2014. In this paper, we argue that a ‘fourth 90’—Ensuring that 90% of all people successfully completing treatment for TB can have a good health-related quality of life'—should be considered. Many individuals who successfully complete anti-TB treatment are burdened with lifelong comorbidities—human immunodeficiency virus (HIV) and diabetes mellitus, obstructive and restrictive lung disease, involving lung destruction, cavitation, fibrosis and bronchiectasis, that either pre-existed or developed as a result of TB (e.g., chronic pulmonary aspergillosis), permanent disabilities such as hearing loss resulting from second-line anti-TB drugs, and mental health disorders. These need to be identified during TB treatment and appropriate care and support provided after anti-TB treatment is successfully completed. A ‘fourth 90’ has also been proposed for the UNAIDS 90-90-90 targets similar in scope to what is being suggested here for TB. Adoption by both HIV and TB control programmes would highlight the current focus on integrated person- and family-centred services