Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives.

Background Since 2018, over 14 million people have been treated for tuberculosis (TB) globally. However, pre-treatment loss to follow-up (PTLFU) has been shown to contribute substantially to patient losses in the TB care cascade with subsequent high community transmission and mortality rates. Objective To identify, appraise, and synthesise evidence on the perspectives of patients and healthcare workers on factors contributing to PTLFU in adults with pulmonary TB. Methods We registered the title with PROSPERO (CRD42021253212). We searched nine relevant databases up to 24 May 2021 for qualitative studies. Two review authors independently reviewed records for eligibility and extracted data. We assessed methodological quality with the Evidence for Policy and Practice Information Centre tool and synthesised data using the Supporting the Use of Research Evidence framework. We assessed confidence in our findings using Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual). Results We reviewed a total of 1239 records and included five studies, all from low- and middle-income countries. Key themes reported by patients and healthcare workers were communication challenges among healthcare workers and between healthcare workers and patients; knowledge, attitudes, and behaviours about TB and its management; accessibility and availability of facilities for TB care; and human resource and financial constraints, weakness in management and leadership in TB programmes. Patients’ change of residence, long waiting times, and poor referral systems were additional factors that contributed to patients disengaging from care. We had moderate confidence in most of our findings. Conclusion Findings from our qualitative evidence synthesis highlight multiple factors that contribute to PTLFU. Central to addressing these factors will be the need to strengthen health systems and offer people-centred care

Policy uptake and implementation of the RTS,S/AS01 malaria vaccine in sub-Saharan African countries: status 2 years following the WHO recommendation

In October 2021, the WHO recommended the world’s first malaria vaccine—RTS,S/AS01—to prevent malaria in children living in areas with moderate-to-high transmission in sub-Saharan Africa (SSA). A second malaria vaccine, R21/Matrix-M, was recommended for use in October 2023 and added to the WHO list of prequalified vaccines in December 2023. This study analysis assessed the country status of implementation and delivery strategies for RTS,S/AS01 by searching websites for national malaria policies, guidelines and related documents. Direct contact with individuals working in malaria programmes was made to obtain documents not publicly available. 10 countries had documents with information relating to malaria vaccine implementation, 7 referencing RTS,S/AS01 and 3 (Burkina Faso, Kenya and Nigeria) referencing RTS,S/AS01 and R21/Matrix-M. Five other countries reported plans for malaria vaccine roll-out without specifying which vaccine. Ghana, Kenya and Malawi, which piloted RTS,S/AS01, have now integrated the vaccine into routine immunisation services. Cameroon and Burkina Faso are the first countries outside the pilot countries to incorporate the vaccine into national immunisation services. Uganda plans a phased RTS,S/AS01 introduction, while Guinea plans to first pilot RTS,S/AS01 in five districts. The RTS,S/AS01 schedule varied by country, with the first dose administered at 5 or 6 months in all countries but the fourth dose at either 18, 22 or 24 months. SSA countries have shown widespread interest in rolling out the malaria vaccine, the Global Alliance for Vaccines and Immunization having approved financial support for 20 of 30 countries which applied as of March 2024. Limited availability of RTS,S/AS01 means that some approved countries will not receive the required doses. Vaccine availability and equity must be addressed even as R21/Matrix-M becomes available

Behavioral Interventions to increase uptake of HIV testing among the Key Populations in sub-Saharan Africa, a scoping review protocol

This is a scoping review to identify interventions that have been used to increase uptake of HIV testing among Key Populations including Men who have Sex with Men (MSM), People Who Inject Drugs (PWIDs) and Female Sex Workers (FSWs) in sub-Saharan Africa. This is important because as HIV incidence is declining, these groups report the highest incidence and hence remain the main HIV infection pathways. Targeting these high infection risk groups is important given the health service access challenges they are currently experiencing due to systematic discrimination and stigma

Reporting and Methodological Quality of Clinical Practice Guidelines for Management of Malnutrition in the East African Community: A Systematic Review Protocol

Background: Clinical Practice Guidelines (CPGs), serve as a framework for healthcare professionals to support therapeutic decisions and best practices for optimising patient care. However, if the guidelines do not sufficiently address all the important components of optimal care, their quality, validity, and impact are reduced. Despite multiple interventions, cases of malnutrition are still high due to the several factors linked to them. Therefore, there is a need to establish the methodological quality of malnutrition CPGs. Objective: To review and critically appraise the methodological quality of CPGs in managing malnutrition within the East African Community (EAC). Methods: We intend to focus on Integrated Management of Acute Malnutrition (IMAM) and Community Integrated Management of Malnutrition (CIMAM) guidelines. We will also focus on guidelines written in English or French and published in the last five years from the last search date or the latest guideline available. We will search the Ministry of Health websites of the EAC countries: Tanzania, Kenya, Uganda, South Sudan, Burundi, Rwanda, and the Democratic Republic of Congo. We will also search Health associations of the respective countries and their e-repositories. Using Google Search Engine, we will use the search terms "clinical practice guidelines, "nutrition guidelines", "nutrition protocols", "health guidelines"," "IMAM", "CIMAM" and "country". Five reviewers will independently select CPGs and extract data in English and French guidelines. We will conduct a quality assessment using the online version of the AGREE II tool across six domains and using the RIGHT reporting checklist. Descriptive statistics will be analysed using STATA software version 17 (Stata Corp LLC, College TX)