Descri[ptive study of surrogate and clinical outcomes of anti-retroviral treatment in Selebi Phikwe, Botswana from June 2004 to June 2005

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011Background Few results are available concerning long-term clinical outcomes in ART treatment programs. The objective of this study was to describe clinical and laboratory outcomes for adult patients commenced on ART in Selebi Phikwe, Botswana from June 2004 to June 2005 within one year of commencement of ART. Methods Cross-sectional descriptive study of clinical and laboratory outcomes for 904 adult patients initiated on ART in Selebi Phikwe, Botswana, from June 2004 to June 2005. Data from ART services statistics was analyzed using descriptive statistical methods. Results Most patients had low a basal CD4 cellular count with a median count of 25 cells, which rose to 147 after 12 months of treatment. Of the 84 (9%) deaths, 75 (89%) had a basal CD4 count of less than 10 cells and 48 (57%) died within three months of commencing of ART Conclusion Good clinical and laboratory outcomes for patients on ART in resource limited are achievable. Mortality commonly occurs among patients with low CD4 counts and within three months of commencement of therapy

Evaluation of a Density-Based Rapid Diagnostic Test for Sickle Cell Disease in a Clinical Setting in Zambia

Although simple and low-cost interventions for sickle cell disease (SCD) exist in many developing countries, child mortality associated with SCD remains high, in part, because of the lack of access to diagnostic tests for SCD. A density-based test using aqueous multiphase systems (SCD-AMPS) is a candidate for a low-cost, point-of-care diagnostic for SCD. In this paper, the field evaluation of SCD-AMPS in a large (n = 505) case-control study in Zambia is described. Of the two variations of the SCD-AMPS used, the best system (SCD-AMPS-2) demonstrated a sensitivity of 86% (82–90%) and a specificity of 60% (53–67%). Subsequent analysis identified potential sources of false positives that include clotting, variation between batches of SCD-AMPS, and shipping conditions. Importantly, SCD-AMPS-2 was 84% (62–94%) sensitive in detecting SCD in children between 6 months and 1 year old. In addition to an evaluation of performance, an assessment of end-user operability was done with health workers in rural clinics in Zambia. These health workers rated the SCD-AMPS tests to be as simple to use as lateral flow tests for malaria and HIV

Descriptive study of HIV/AIDS-related stigma experienced by people living with HIV/AIDS (PLWHA) in healthcare settings offering family planning and/or HIV services in Kapiri-Mposhi, Zambia

Thesis (MPhil)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Few results are available describing the experiences of people living with HIV/AIDS in health care setting in Zambia. Describing and understanding the experiences of people living with HIV/AIDS (PLWHA) in health care settings would allow the Zambian health system to improver position health interventions to maximally benefit the PLWHA. The objective of this study is to describe experiences of PLWHA while accessing HIV and family planning services (health care settings) in Kapiri-Mposhi, Zambia from the time they were diagnosed with HIV to 2011. A cross-sectional descriptive study of experiences of PLWHA was conducted while accessing HIV and family planning services (in a health care setting) in Kapiri-Mposhi, Zambia from the time they were diagnosed with HIV to 2011. Data was collected from a convenient sample of 100 PLWHA attending HIV and/or family planning services on the dates of interviews by administering a questionnaire. Data was analyzed using descriptive statistical methods and presented in figures and tables in the text. PLWHA still experience stigma and discrimination in health care setting related to: disclosure of their HIV status without consent, being coerced into taking an HIV test and being denied services, including family planning services. More education is needed for the health care workers in order to reduce HIV-related stigma and discrimination.AFRIKAANSE OPSOMMING: Weinig inligting is beskikbaar aangaande die persoonlike belewenisse van MIV/VIGS pasiënte (verkort as PLWHA) in Zambiese sorgeenhede. Die studie stel dit ten doel om kennis en insig te bekom betreffende die ervarings van pasiënte met die gesinsbeplanningsdienste in Kapiri-Mposhi in Zambië. Die studie fokus op die pasiënte se beskrywing van hul ervarings met die siekte, asook die behandeling ontvang in die sorgeenhede sedert hul eerste diagnose tot en met 2011. „n Deursnee profiel van die pasiënte se ervarings met gesondheidsdienste is bekom deur persoonlike onderhoude te voer met „n gerieflikheidsmonster van een honderd pasiënte. Die persone het ten tye van die ondersoek, gebruik gemaak het van dienste by die sorgeenheid in Kapiri–Mposhi. Die onderhoude is aangevul deur vraelyste. Die kwalitatiewe en kwantitatiewe inligting is verwerk en waar toepaslik verder deur beskrywende statistiese metodes ontleed en grafies toegelig. Inligting verkry deur die toepassing van bogenoemde metodes dui op die volgende: Pasiënte ervaar stigma en diskriminasie in die sorgeenhede omdat hul MIV-status sonder hulle toestemming bekend gemaak word; hulle voel geforseerd om MIV-toetsing te ondergaan; hulle is van mening dat hulle sekere dienste ontsê word en ook nie behoorlike toegang tot gesinsbeplanning ontvang nie. Die studie dui op die noodsaaklikheid vir beter opleiding van gesondheidsdienswerkers ten einde die ervaring van stigma en die persepsie van diskriminasie behoorlik aan te spreek en uit die weg te ruim

The Prevalence of Tuberculosis in Zambia: Results from the First National TB Prevalence Survey, 2013-2014.

BACKGROUND:Tuberculosis in Zambia is a major public health problem, however the country does not have reliable baseline data on the TB prevalence for impact measurement; therefore it was among the priority countries identified by the World Health Organization to conduct a national TB prevalence survey. OBJECTIVE:To estimate the prevalence of tuberculosis among the adult Zambian population aged 15 years and above, in 2013-2014. METHODS:A cross-sectional population-based survey was conducted in 66 clusters across all the 10 provinces of Zambia. Eligible participants aged 15 years and above were screened for TB symptoms, had a chest x-ray (CXR) performed and were offered an HIV test. Participants with TB symptoms and/or CXR abnormality underwent an in-depth interview and submitted one spot- and one morning sputum sample for smear microscopy and liquid culture. Digital data collection methods were used throughout the process. RESULTS:Of the 98,458 individuals who were enumerated, 54,830 (55.7%) were eligible to participate, and 46,099 (84.1%) participated. Of those who participated, 45,633/46,099 (99%) were screened by both symptom assessment and chest x-ray, while 466/46,099 (1.01%) were screened by interview only. 6,708 (14.6%) were eligible to submit sputum and 6,154/6,708 (91.7%) of them submitted at least one specimen for examination. MTB cases identified were 265/6,123 (4.3%). The estimated national adult prevalence of smear, culture and bacteriologically confirmed TB was 319/100,000 (232-406/100,000); 568/100,000 (440-697/100,000); and 638/100,000 (502-774/100,000) population, respectively. The risk of having TB was five times higher in the HIV positive than HIV negative individuals. The TB prevalence for all forms was estimated to be 455 /100,000 population for all age groups. CONCLUSION:The prevalence of tuberculosis in Zambia was higher than previously estimated. Innovative approaches are required to accelerate the control of TB

Schematic of the density-based tests to identify SCD.

<p>Both versions of the SCD-AMPS are designed to separate dense red blood cells present in SCD from whole blood. Blood passes through the phases—top (T) and bottom (B) for SCD-AMPS-2 and top (T), middle (M), and bottom (B) for SCD-AMPS-3—upon centrifugation. If sickled cells are present, they collect at the interface between the bottom phase and the seal (<i>B/S</i>), and provide a visual readout for the presence of SCD. In SCD-AMPS-3, the additional phase allows the discrimination of Hb SS from Hb SC by evaluating the distribution of red cells at the upper interfaces (between the top and middle phases (<i>T/M</i>) and the middle and bottom phases (<i>M/B</i>).</p

Tabulation of Results of SCD-AMPS Tests Compared to Reference Test Results by Hemoglobin Electrophoresis.

<p>*Samples found to have>50% Hb S but non-zero levels of Hb A, potentially a result of Hb S with β-thalassemia or a transfused Hb SS subject.</p><p>Tabulation of Results of SCD-AMPS Tests Compared to Reference Test Results by Hemoglobin Electrophoresis.</p

Basic Characteristics of the Study Population.

<p>Basic Characteristics of the Study Population.</p

The sensitivity and specificity of SCD-AMPS as a function of the amount of time between collecting samples and running tests.

<p>The specificity shows a decline over each 24 hour increment, with a significant decline over 48 hours (p-value <0.0005). The sensitivity increased between the first and second time interval, but then decreased between the second and third interval (p-values <0.01). The sample size used for each time interval is provided below each bar.</p

Equipment for the SCD-AMPS rapid test.

<p>All the equipment necessary to run the rapid test in a rural clinic fits inside a backpack and were evaluated at rural health centers in Zambia.</p

Inclusion and Exclusion Criteria for Study.

<p>Inclusion and Exclusion Criteria for Study.</p