Delayed initiation of anti-retroviral therapy in TB/HIV co-infected patients, Sanyati District, Zimbabwe, 2011-2012

Introduction: tuberculosis (TB) remains a public health problem and is driven by HIV. Recent studies indicate that anti-retroviral therapy (ART) initiated during the first two months of anti-TB treatment (ATT) reduces risk of HIV morbidity and mortality. In Sanyati district, 14% of TB/HIV coinfected patients were initiated on ART during TB treatment, in 2010. The study was conducted to determine the magnitude and determinants of delay in ART initiation, in TB/HIV co-infected patients. Methods: an analytic cross sectional study was conducted at three study sites in Sanyati district. The outcome was delayed ART initiation, being failure to be initiated on ART during the first two months of ATT. Respondents were interviewed using pre-tested questionnaires. Epi-InfoTM was used to generate frequencies, means, odds ratios and 95% confidence intervals. Stratified and logistic regression analysis was done. Results: of the 186 respondents, 63% had delayed ART initiation. Median delay from initiation of ATT to ART was 48 days (Q1=20; Q3=82). Risk factors for delayed ART initiation were: being treated for TB first time, AOR=2.23 (p=0.03); initially registered for HIV care outside Sanyati, AOR=3.08 (p<0.01); staying more than 5km from a clinic, AOR=3.29 (p<0.01). Enabling factors for early ART initiation was having a family member on ART, AOR=0.23 (p<0.01). Conclusion: significant delay and barriers to ART initiation were identified. Decentralization of ART initiation should be expedited. ART initiation should be expedited in patients with identified risk factors fordelaying ART initiation. Peer support should be strengthened in families and community. Periodic evaluation of magnitude of delay and impact of early ART initiation in TB/HIV patients is recommended.Keywords: Tuberculosis, HIV, delay, initiation, anti-retroviral therapy, Sanyati, Zimbabw

Typhoid outbreak investigation in Dzivaresekwa, suburb of Harare City, Zimbabwe, 2011

Introduction: Typhoid fever is a systemic infection caused by a Gram negative bacterium, Salmonella  typhi. Harare City reported 1078 cases of suspected typhoid fever cases from October  011 to January 2012. We initiated an investigation to identify possible source of transmission so as to institute control measures. Methods: An unmatched 1:1 case-control study was conducted. A questionnaire was administered to study participants to identify risk factors for contracting typhoid. A case was a resident of Dzivaresekwa who presented with signs and symptoms of typhoid between October and December 2011. Water  samples were collected for microbiological analysis. Results: 115 cases and 115 controls were enrolled. Drinking water from a well (OR= 6.2 95% CI  (2.01-18.7)), attending a gathering (OR= 11.3 95% CI (4.3-29.95)), boiling drinking water (OR= 0.21 95% CI (0.06-0.76)) and burst sewer pipe at home (OR= 1.19 95% CI (0.67-2.14)) were factors  associated with contracting typhoid. Independent risk factors for contracting typhoid were drinking water from a well (AOR=5.8; 95% CI (1.90-17.78)), and burst sewer pipe at home (AOR=1.20; 95% CI (1.10-2.19)). Faecal coli forms and E. coli were isolated from 8/8 well water samples. Stool, urine and blood specimens were cultured and serotyped for Salmonella typhi and 24 cases were confirmed positive. Shigella, Giardia and E coli were also isolated. Ciprofloxacin, X-pen and Rocephin were used for case  management. No complications were reported. Conclusion: Contaminated water from unprotected water sources was the probable source of the  outbreak. Harare City Engineer must invest in repairing water and sewage reticulation systems in the city.Key words: Typhoid, outbreak investigation, contaminated water, Zimbabwe