Determinants of sputum ordering for tuberculosis diagnosis in people living with HIV in the Greater Accra Region, Ghana

Background: This study assessed factors associated with sputum ordering for tuberculosis (TB) diagnosis in people living with HIV (PLHIV) who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.Objective: This study assessed the factors associated with sputum ordering in PLHIV with a positive TB symptom screen test.Methods: A mixed-method cross-sectional study was undertaken at three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana. The study involved a review of 400 patients' charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Bivariate analysis using a Chi-square test and Logistic regression for multivariate analysis were used to establish factors associated with sputum ordering. Factors having a p ≤ 0.05 were considered significantly associated with sputum ordering. Inductive thematic analysis was used to explain the associated factors.Results: Of the 400 charts reviewed, 67.7% were female patients with a median age of 39 (IQR 31 ̶ 49). TB screening was recorded in 78% (n = 312/400, 95% CI: 73.6 ̶ 82.0) of the patients, of whom ninety-two (92) patients had a positive TB screen test. Only 57.6% (n = 53) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, the patient's general appearance was described as abnormal (OR = 3.05, p = 0.036), having more than one TB symptom (OR = 3.42, p = 0.028) and presence of an alternative presumptive diagnosis (OR = 0.34, p = 0.023) were associated with having a sputum test ordered. High patient numbers, the inability to produce sputum, the unwillingness of moderately sick patients to provide sputum and the cost associated with chest X-rays were perceived as the challenges to further testing for TB.Conclusion: Almost half of PLHIV with a positive TB screen test did not have a sputum test documented. This calls for instituting measures to address the barriers to TB screening among people living with HIV/AIDS for effective TB and HIV comorbidity management

The Medical Research Council (UK)/Uganda Virus Research Institute Uganda Research Unit on AIDS--'25 years of research through partnerships'.

For the past 25 years, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit have contributed to the understanding and control of the HIV epidemic both in Uganda and globally, and informed the future development of biomedical HIV interventions, health policy and practice. In this report, as we celebrate our silver jubilee, we describe some of these achievements and the Unit's multidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplar of a partnership that has been largely funded from the north but led in the south

Schistosomiasis among Recreational Users of Upper Nile River, Uganda, 2007

After recreational exposure to river water in Uganda, 12 (17%) of 69 persons had evidence of schistosome infection. Eighteen percent self-medicated with praziquantel prophylaxis immediately after exposure, which was not appropriate. Travelers to schistosomiasis-endemic areas should consult a travel medicine physician

Social Enterprise Evaluation : Implications for Tourism Development

The evaluation of social enterprise projects has focused mainly on devising effective performance measurement methods and processes to justify the investment of resources and time committed to such activities. With increasing demands for accountability, effectiveness, evidence of return on investment and value-added results, evaluation activities have been driven by imperatives of objectivity in assessments and the development of tools that monetize the social outcomes and impacts of social enterprise projects. These traditional approaches to evaluation have also been widely adapted in tourism based social enterprises that seek to attain goals of poverty alleviation, empowerment of local communities, and improved livelihoods for those marginalized from mainstream tourism economic activities. This chapter argues that traditional approaches to evaluation may be limited in supporting social entrepreneurship projects with development objectives of empowerment and societal change. It is proposed that social enterprise projects involving community participation may be better positioned to achieve their developmental objectives by incorporating more of the principles of Participatory Evaluation (PE) and Empowerment Evaluation (EE) in the quest to harness the economic prowess of tourism for human development

Transmitted antiretroviral drug resistance surveillance among newly HIV type 1-diagnosed women attending an antenatal clinic in Entebbe, Uganda.

To evaluate transmitted HIV-1 drug resistance and study the natural polymorphism in pol of HIV-1 strains of newly diagnosed women attending an antenatal clinic in Uganda we sequenced the protease and reverse transcriptase genes for 46 HIV-1 strains from the threshold surveillance. Of the 46 sequences analyzed, 48.0% were subtype A1 (n 22), 39.0% subtype D (n 18), 2.0% subtype A2 (n 1), 2.0% subtype C (n 1), and 9.0% intersubtype recombinant A1/D (n 4). Overall, many minor mutations were identified in the protease sequences. None of the strains had major associated mutations to any RTI drug or drug class interest after genotyping 37 samples of our cohort. The HIV drug resistance prevalence estimate in Entebbe following the HIVDR-TS methodology is less than 5% as set out by WHO guidelines