Commentary - Key stakeholders’ perspectives on prioritization of services for chronic respiratory diseases (CRDs) in Tanzania and Sudan: Implications in the COVID-19 era

Key Messages● Despite significant morbidity and mortality and socioeconomic consequences, chronic respiratory diseases (CRDs) are underprioritized in public health programs, especially in low-and middle income countries (LMICs)● COVID-19 is compounding this lack of prioritization and negatively impacting CRD-related (and other) health-care access, diagnosis, and management● Risk factors for exposure to untreated COVID-19, other respiratory infections, and CRDs overlap and could be addressed in concert● Prioritization of COVID-19 within the health system is likely to last for years, potentially allowing advocates to reframe the prioritization of CRDs as part of the pandemic preparedness and integration of health care. This includes advocating for approaches that integrate CRDs into existing programs and services systems strengthening

The burden and determinants of post-TB lung disease in Tanzanian adults: a cross-sectional study

BACKGROUND: Post-TB lung disease (PTLD) is an important but under-recognised chronic respiratory disease in high TB burden settings such as Tanzania. METHODS: This was a cross-sectional survey of adults within 2 years of completion of TB treatment in Kilimanjaro, Tanzania. Data were collected using questionnaires (symptoms and exposures), spirometry and chest radiographs to assess outcome measures, which were correlated with daily life exposures, including environment and diet. RESULTS: Of the 219 participants enrolled (mean age: 45 years ± 10; 193 [88%] males), 98 (45%) reported chronic respiratory symptoms; 46 (22%) had received treatment for TB two or more times; and HIV prevalence was 35 (16%). Spirometric abnormalities were observed in 146 (67%). Chest X-ray abnormalities occurred in 177 (86%). A diagnosis of PTLD was made in 200 (91%), and half had clinically relevant PTLD. The prevalence of ≥Grade 3 modified Medical Research Council chronic bronchitis and dyspnoea was respectively 11% and 26%. Older age, multiple episodes of TB and poverty indicators were linked with clinically relevant PTLD. CONCLUSIONS: We found a substantial burden of PTLD in adults who had recently completed TB treatment in Tanzania. There is a pressing need to identify effective approaches for both the prevention and management of this disease

Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

Background Chronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. Methods We conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains. Results One health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Conclusions Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart

Key stakeholders’ perspectives on prioritization of services for chronic respiratory diseases (CRDs) in Tanzania and Sudan: Implications in the COVID-19 era

Key Messages ● Despite significant morbidity and mortality and socioeconomic consequences, chronic respiratory diseases (CRDs) are underprioritized in public health programs, especially in low-and middle income countries (LMICs) ● COVID-19 is compounding this lack of prioritization and negatively impacting CRD-related (and other) health-care access, diagnosis, and management ● Risk factors for exposure to untreated COVID-19, other respiratory infections, and CRDs overlap and could be addressed in concert ● Prioritization of COVID-19 within the health system is likely to last for years, potentially allowing advocates to reframe the prioritization of CRDs as part of the pandemic preparedness and integration of health care. This includes advocating for approaches that integrate CRDs into existing programs and services systems strengthenin

Perception and Risk Factors Associated with Tuberculosis in the Manyara Region, Tanzania2

A research article is submitted to Zoonotic Disease 2023, volume 3Tuberculosis (TB) results from infection with members of the Mycobacterium tuberculosis complex (MTBC) and represents a major global public health concern. We here sought to assess the perceptions of human and animal TB and the prevalence of circulating MTBCs lineages and associated risk factors through a cross-sectional survey of 335 individuals presenting with symptoms of pulmonary or extrapulmonary TB in the Manyara region of Tanzania. After the enrollment of participants, a questionnaire survey was conducted, samples were collected for bacterial culture, and real-time multiplex PCR was performed to differentiate amongst primary animal and human MTBC lineages. The results show poor TB awareness: 31.6% of the participants were not aware of human TB; 82.4% were unaware of animal TB and 95.2% lacked awareness of zoonotic TB (zTB) transmission. A total of 18 recovered specimens (5%; 95% CI: 3–8%) were positive by culture, all of which were typed as M. tuberculosis sensu stricto using a lineage-specific PCR assay. While no single risk factor was significantly associated with MTBC culture positivity, the survey revealed considerable self-reported high-risk practices for contracting zTB. Together, the results show that Manyara residents have poor knowledge of diseases caused by MTBCs and high evidence of risky practices for contracting zT

Implementation and effectiveness of evriMED with short messages service (SMS) reminders and tailored feedback compared to standard care on adherence to treatment among tuberculosis patients in Kilimanjaro, Tanzania: Proposal for a cluster randomized controlled trial

Background: Adherence to tuberculosis (TB) treatment is challenging because of many factors. The World Health Organization has recommended the use of digital adherence monitoring technologies in its End TB Strategy. However, evidence on improving adherence is limited. EvriMED is a real-time medication-monitoring device which was found to be feasible and acceptable in a few studies in Asia. In Tanzania, however, there may be challenges in implementing evriMED due to stigmatization, network and power access, accuracy, and cost effectiveness, which may have implications for treatment outcome. We propose a pragmatic cluster randomized trial to investigate the effectiveness of evriMED with reminder cues and tailored feedback on adherence to TB treatment in Kilimanjaro, Tanzania. Methods/design: We will create clusters in Kilimanjaro based on level of health care facility. Clusters will be randomized in an intervention arm, where evriMED will be implemented, or a control arm, where standard practice directly observed treatment will be followed. TB patients in intervention clusters will take their medication from the evriMED pillbox and receive tailored feedback. We will use the 'Stages of Change' model, which assumes that a person has to go through the stages of pre-contemplation, contemplation, preparation, action, and evaluation to change behavior for tailored feedback on adherence reports from the device. Discussion: If the intervention shows a significant effect on adherence and the devices are accepted, accurate, and sustainable, the intervention can be scaled up within the National Tuberculosis Programmes. Trial registration: Pan African Clinical Trials Registry, PACTR201811755733759. Registered on 8 November 2018