Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa

Objectives: Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity – particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management. Methods: A decision analytic model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon 1) a study of pregnant women in Botswana, 2) literature reviews and 3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment. Results: Azithromycin was less costly and more effective than was erythromycin. Compared to syndromic management, testing all attendees on their first visit with a 75$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management. Conclusions: Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does – and at acceptable costs – especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people’s health and even reduce health care budgets.Chlamydia trachomatis (MeSH); Cost-effectiveness analysis (non-MeSH); Cost Analysis (MeSH); Developing countries (MeSH); Africa (MeSH); Sub-Saharan Africa (MeSH) Maternal health (non-MeSH); Maternal Health Services (MeSH); Women’s Health (MeSH); Point-of-care tests (non-MeSH); Diagnostic tests (non-MeSH); Diagnosis (MeSH); Syndromic approach (non-MeSH); STI management (non-MeSH)

Patient and health care system delays in the start of tuberculosis treatment in Norway

BACKGROUND: Delay in start of tuberculosis (TB) treatment has an impact at both the individual level, by increasing the risk of morbidity and mortality, and at the community level, by increasing the risk of transmission. The aims of this study were to assess the delays in the start of treatment for TB patients in Oslo/Akershus region, Norway and to analyze risk factors for the delays. METHODS: This study was based on information from the National TB Registry, clinical case notes from hospitals and referral case notes from primary health care providers. Delays were divided into patient, health care system and total delays. The association with sex, birthplace, site of the disease and age group was analyzed by multiple linear regression. RESULTS: Among the 83 TB patients included in this study, 71 (86%) were born abroad. The median patient, health care system and total delays were 28, 33 and 63 days respectively, with a range of 1–434 days. In unadjusted analysis, patient delay and health care system delay did not vary significantly between men and women, according to birthplace or age group. Patients with extra-pulmonary TB had a significantly longer patient, health care system and total delay compared to patients with pulmonary TB. Median total delay was 81 and 56 days in the two groups of TB patients respectively. The health care system delay exceeded the patient delay for those born in Norway. The age group 60+ years had significantly shorter patient delay than the reference group aged 15–29 years when adjusted for multiple covariates. Also, in the multivariate analysis patients born in Norway had significantly longer health care system delay than patients born abroad. CONCLUSION: A high proportion of patients had total delays in start of TB treatment exceeding two months. This study emphasizes the need of awareness of TB in the general population and among health personnel. Extra-pulmonary TB should be considered as a differential diagnosis in unresolved cases, especially for immigrants from high TB prevalence countries

Risikofaktorer for hepatitt C-smitte blant sprøytemisbrukere

Hepatitt C-virusinfeksjon er vanlig blant injiserende stoffmisbrukere. Målet med denne studien var å undersøke forekomst av risikoatferd blant injiserende stoffmisbrukere i Oslo og deres assosiasjon med hepatitt C-smitte. Materiale og metode. Dette er en tverrsnittsundersøkelse, der 327 brukere av sprøytebussen i Oslo valgte å delta. Det ble foretatt et strukturert intervju som fokuserte på type rusmisbruk og risikoatferd med tanke på smitte. Blodprøver ble undersøkt for anti-hepatitt C-virus (anti-HCV) (EIA-3) og HCV-RNA (internt utført PCR). Resultater: Prevalensen av HCV-RNA var 51 %, og 81% var anti-HCV-positive (anti-HCV+). I en multivariatanalyse var anti-HCV+ assosiert med debutalder for sprøytemisbruk 34 år, deling av sprøyter, sprøytemisbruk i fengsel, deling av dose fra felles sprøyte og heroinbruk. En av fem med anti-HCV+ oppga aldri å ha delt sprøyter, men anti-HCV+ var ikke assosiert med deling av annet brukerutstyr enn sprøyter. Målt i de siste fire ukene før intervjuet var deling av sprøyter vanligere blant gifte/samboende enn aleneboende. Fortolkning: De fleste sprøytemisbrukere i Oslo er blitt eksponert for hepatitt C (anti HCV+), og halvparten har utviklet kronisk infeksjon (HCV-RNA+). Hepatitt C-smitte var blant annet assosiert med deling av dose fra felles sprøyte og deling av sprøyter, særlig i fengsel. Deling av annet utstyr enn sprøyter var ikke assosiert med smitte

Treatment outcome of new culture positive pulmonary tuberculosis in Norway

BACKGROUND: The key elements in tuberculosis (TB) control are to cure the individual patient, interrupt transmission of TB to others and prevent the tubercle bacilli from becoming drug resistant. Incomplete treatment may result in excretion of bacteria that may also acquire drug resistance and cause increased morbidity and mortality. Treatment outcome results serves as a tool to control the quality of TB treatment provided by the health care system. The aims of this study were to evaluate the treatment outcome for new cases of culture positive pulmonary TB registered in Norway during the period 1996–2002 and to identify factors associated with non-successful treatment. METHODS: This was a register-based cohort study. Treatment outcome was assessed according to sex, birthplace, age group, isoniazid (INH) susceptibility, mode of detection and treatment periods (1996–1997, 1998–1999 and 2000–2002). Logistic regression was also used to estimate the odds ratio for treatment success vs. non-success with 95% confidence interval (CI), taking the above variables into account. RESULTS: Among the 655 patients included, the total treatment success rate was 83% (95% CI 80%–86%). The success rates for those born in Norway and abroad were 79% (95% CI 74%–84%) and 86% (95% CI 83%–89%) respectively. There was no difference in success rates by sex and treatment periods. Twenty-two patients (3%) defaulted treatment, 58 (9%) died and 26 (4%) transferred out. The default rate was higher among foreign-born and male patients, whereas almost all who died were born in Norway. The majority of the transferred out group left the country, but seven were expelled from the country. In the multivariate analysis, only high age and initial INH resistance remained as significant risk factors for non-successful treatment. CONCLUSION: Although the TB treatment success rate in Norway has increased compared to previous studies and although it has reached a reasonable target for treatment outcome in low-incidence countries, the total success rate for 1996–2002 was still slightly below the WHO target of success rate of 85%. Early diagnosis of TB in elderly patients to reduce the death rate, abstaining from expulsion of patients on treatment and further measures to prevent default could improve the success rate further

Risikofaktorer for hepatitt C-smitte blant sprøytemisbrukere

Hepatitt C-virusinfeksjon er vanlig blant injiserende stoffmisbrukere. Målet med denne studien var å undersøke forekomst av risikoatferd blant injiserende stoffmisbrukere i Oslo og deres assosiasjon med hepatitt C-smitte. Materiale og metode. Dette er en tverrsnittsundersøkelse, der 327 brukere av sprøytebussen i Oslo valgte å delta. Det ble foretatt et strukturert intervju som fokuserte på type rusmisbruk og risikoatferd med tanke på smitte. Blodprøver ble undersøkt for anti-hepatitt C-virus (anti-HCV) (EIA-3) og HCV-RNA (internt utført PCR). Resultater: Prevalensen av HCV-RNA var 51 %, og 81% var anti-HCV-positive (anti-HCV+). I en multivariatanalyse var anti-HCV+ assosiert med debutalder for sprøytemisbruk 34 år, deling av sprøyter, sprøytemisbruk i fengsel, deling av dose fra felles sprøyte og heroinbruk. En av fem med anti-HCV+ oppga aldri å ha delt sprøyter, men anti-HCV+ var ikke assosiert med deling av annet brukerutstyr enn sprøyter. Målt i de siste fire ukene før intervjuet var deling av sprøyter vanligere blant gifte/samboende enn aleneboende. Fortolkning: De fleste sprøytemisbrukere i Oslo er blitt eksponert for hepatitt C (anti HCV+), og halvparten har utviklet kronisk infeksjon (HCV-RNA+). Hepatitt C-smitte var blant annet assosiert med deling av dose fra felles sprøyte og deling av sprøyter, særlig i fengsel. Deling av annet utstyr enn sprøyter var ikke assosiert med smitte

E4L

Illumina MiSeq data from PCR amplification of seawater sample