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  • 1
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    Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 9 ( 2021-9-17), p. e0257486-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 9 ( 2021-9-17), p. e0257486-
    Abstract: Tuberculosis screening of people living with human immunodeficiency virus is an intervention recommended by the WHO to control the dual epidemic of TB and HIV. The extent to which the intervention is adhered to by the HIV healthcare providers (fidelity) determines the intervention’s effectiveness as measured by patient outcomes, but literature on fidelity is scarce. This study assessed provider implementation fidelity to national guidelines on TB screening at HIV clinics in Ghana. Methods It was a cross-sectional study that used structured questionnaires to gather data, involving 226 of 243 HIV healthcare providers in 27 HIV clinics across Ghana. The overall fidelity score comprised sixteen items with a maximum score of 48 grouped into three components of the screening intervention (TB diagnosis, TB awareness and TB symptoms questionnaire). Simple summation of item scores was done to determine fidelity score per provider. In this paper, we define the level of fidelity as low if the scores were below the median score and were otherwise categorized as high. Background factors potentially associated with implementation fidelity level were assessed using cluster-based logistic regression. Odds ratio with 95% confidence interval (CI) was used as the measure of association. Results Of the 226 healthcare providers interviewed, 60% (135) were females with a mean age of 34.5 years (SD = 8.3). Most of them were clinicians [63% (142)] and had post-secondary non-tertiary education [62% (141)] . Overall, 53% (119) of the healthcare providers were categorized to have implemented the intervention with high fidelity. Also, 56% (126), 53% (120), and 59% (134) of the providers implemented the TB diagnosis, TB awareness and TB symptoms questionnaire components respectively with high fidelity. After adjusting for cluster effect, female providers (AOR = 2.36, 95%CI: 1.09–5.10, p = 〈 0.029), those with tertiary education (AOR = 4.31, 95%CI: 2.12–9.10, p = 0.040), and clinicians (AOR = 1.78, 95%CI: 1.07–3.50, p = 0.045) were more likely to adhere to the guidelines compared to their counterparts. Conclusion The number of providers with fidelity scores above the median was marginally greater (6%) than the number with fidelity score below the median. Similarly, for each of the components, the number of providers with fidelity scores higher than the median was marginally higher. This could explain the existing fluctuations in the intervention outcomes in Ghana. We found gender, profession and education were associated with provider implementation fidelity. To improve fidelity level among HIV healthcare providers, and realize the aims of the TB screening intervention among PLHIV in Ghana, further training on implementing all components of the intervention is critical.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0257486
    DOI: 10.1371/journal.pone.0257486.g001
    DOI: 10.1371/journal.pone.0257486.g002
    DOI: 10.1371/journal.pone.0257486.g003
    DOI: 10.1371/journal.pone.0257486.g004
    DOI: 10.1371/journal.pone.0257486.t001
    DOI: 10.1371/journal.pone.0257486.t002
    DOI: 10.1371/journal.pone.0257486.t003
    DOI: 10.1371/journal.pone.0257486.t004
    DOI: 10.1371/journal.pone.0257486.t005
    DOI: 10.1371/journal.pone.0257486.t006
    DOI: 10.1371/journal.pone.0257486.s001
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 2
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    Adherence of HIV clinics to guidelines for the delivery of TB screening among people living with HIV/AIDS in Ghana
    Springer Science and Business Media LLC ; 2021
    In:  BMC Health Services Research Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Tuberculosis screening of people living with HIV (PLHIV) – an intervention to reduce the burden of TB among PLHIV – is being implemented at HIV clinics in Ghana since 2007, but TB screening coverage remains low. Facility adherence to intervention guidelines may be a factor but is missing in implementation science literature. This study assesses the level of HIV clinic adherence to the guidelines and related facility characteristics in selected district hospitals in Ghana. Methods This cross-sectional study was conducted in all 27 district hospitals with HIV clinics, X-ray and geneXpert machines in Ghana. These hospitals are in 27 districts representing about 27% of the 100 district hospitals with HIV clinics in Ghana. A data collection tool with 18-items (maximum score of 29) was developed from the TB/HIV collaborative guidelines to assess facility adherence to four interrelated components of the TB screening programme as stated in the guidelines: intensive TB case-finding among PLHIV (ITCF), Isoniazid preventive therapy initiation (IPT), TB infection control (TIC), and programme review meetings (PRM). Data were collected through record review and interviews with 27 key informants from each hospital. Adherence scores per component were summed to determine an overall adherence score per facility and summarized using medians and converted to proportions. Facility characteristics were assessed and compared across facilities with high (above median) versus low (below median) overall adherence scores, using nonparametric test statistics. Results From the 27 key interviews and facility records reviewed, the median adherence scores for ITCF, IPT, TIC, and PRM components were 85.7% (IQR: 85.5–100.0), 0% (IQR: 0–66.7), 33.3% (IQR: 33.3–50.0), and 90.0% (IQR: 70.0–90.0), respectively. The overall median adherence score was 62.1% (IQR: 58.6–65.1), and 17 clinics (63%) with overall adherence score above the median were categorized as high adherence. Compared to low adherence facilities, high adherence facilities had statistically significant lower PLHIV clinic attendees per month (256 (IQR: 60–904) vs. 900 (IQR: 609–2622); p  = 0.042), and lower HIV provider workloads (28.6 (IQR: 8.6–113) vs. 90 (IQR: 66.7–263.5); p  = 0.046), and most had screening guidelines (76%, p   〈  0.01) and questionnaire (80%, p   〈  0.01) available on-site. Conclusion PRM had highest score while the IPT component had the lowest score. Almost a third of the facilities implemented the TB screening programme activities with a high level of adherence to the guidelines. We suggest to ensure adherence to all four components, reducing staff workloads and making TB screening questionnaires and guidelines available on-site would increase facility adherence to the intervention and ultimately achieve intervention targets.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-021-07121-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050434-2
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  • 3
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    Markov modelling of viral load adjusting for CD4 orthogonal variable and multivariate conditional autoregressive mapping of the HIV immunological outcomes among ART patients in Zimbabwe
    Springer Science and Business Media LLC ; 2021
    In:  Theoretical Biology and Medical Modelling Vol. 18, No. 1 ( 2021-12)
    Details
    In: Theoretical Biology and Medical Modelling, Springer Science and Business Media LLC, Vol. 18, No. 1 ( 2021-12)
    Abstract: This study aimed to jointly model HIV disease progression patterns based on viral load (VL) among adult ART patients adjusting for the time-varying “incremental transients states” variable, and the CD4 cell counts orthogonal variable in a single 5-stage time-homogenous multistate Markov model. We further jointly mapped the relative risks of HIV disease progression outcomes (detectable VL (VL ≥ 50copies/uL) and immune deterioration (CD4  〈  350cells/uL) at the last observed visit) conditional not to have died or become loss to follow-up (LTFU). Methods Secondary data analysis of individual-level patients on ART was performed. Adjusted transition intensities, hazard ratios (HR) and regression coefficients were estimated from the joint multistate model of VL and CD4 cell counts. The mortality and LTFU transition rates defined the extent of patients’ retention in care. Joint mapping of HIV disease progression outcomes after ART initiation was done using the Bayesian intrinsic Multivariate Conditional Autoregressive prior model. Results The viral rebound from the undetectable state was 1.78times more likely compared to viral suppression among patients with VL ranging from 50-1000copies/uL. Patients with CD4 cell counts lower than expected had a higher risk of viral increase above 1000copies/uL and death if their VL was above 1000copies/uL (state 2 to 3 ( λ 23 ): HR = 1.83 and ( λ 34 ): HR = 1.42 respectively). Regarding the time-varying effects of CD4 cell counts on the VL transition rates, as the VL increased, ( λ 12 and λ 23 ) the transition rates increased with a decrease in the CD4 cell counts over time. Regardless of the individual’s VL, the transition rates to become LTFU decreased with a decrease in CD4 cell counts. We observed a strong shared geographical pattern of 66% spatial correlation between the relative risks of detectable VL and immune deterioration after ART initiation, mainly in Matabeleland North. Conclusion With high rates of viral rebound, interventions which encourage ART adherence and continual educational support on the barriers to ART uptake are crucial to achieve and sustain viral suppression to undetectable levels. Area-specific interventions which focus on early ART screening through self-testing, behavioural change campaigns and social support strategies should be strengthened in heavily burdened regions to sustain the undetectable VL. Sustaining undetectable VL lowers HIV transmission in the general population and this is a step towards achieving zero HIV incidences by 2030.
    Type of Medium: Online Resource
    ISSN: 1742-4682
    URL: Article
    DOI: 10.1186/s12976-021-00145-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2156462-0
    SSG: 12
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  • 4
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    Infant mortality in South Africa - distribution, associations and policy implications, 2007: an ecological spatial analysis
    Springer Science and Business Media LLC ; 2011
    In:  International Journal of Health Geographics Vol. 10, No. 1 ( 2011), p. 61-
    Details
    In: International Journal of Health Geographics, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2011), p. 61-
    Type of Medium: Online Resource
    ISSN: 1476-072X
    URL: Article
    DOI: 10.1186/1476-072X-10-61
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2011
    detail.hit.zdb_id: 2091613-9
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  • 5
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    An exploratory spatial analysis of geographical inequalities of birth intervals among young women in the Democratic Republic of Congo (DRC): a cross-sectional study
    Springer Science and Business Media LLC ; 2014
    In:  BMC Pregnancy and Childbirth Vol. 14, No. 1 ( 2014-12)
    Details
    In: BMC Pregnancy and Childbirth, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2014-12)
    Type of Medium: Online Resource
    ISSN: 1471-2393
    URL: Article
    DOI: 10.1186/1471-2393-14-271
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2014
    detail.hit.zdb_id: 2059869-5
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  • 6
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    The prevalence of human papillomavirus infections and associated risk factors in men-who-have-sex-with-men in Cape Town, South Africa
    Springer Science and Business Media LLC ; 2016
    In:  BMC Infectious Diseases Vol. 16, No. 1 ( 2016-12)
    Details
    In: BMC Infectious Diseases, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2016-12)
    Type of Medium: Online Resource
    ISSN: 1471-2334
    URL: Article
    DOI: 10.1186/s12879-016-1706-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2016
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  • 7
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    Joint modelling of time-to-clinical malaria and parasite count in a cohort in an endemic area
    Herbert Publications PVT LTD ; 2019
    In:  Journal of Medical Statistics and Informatics Vol. 7, No. 1 ( 2019), p. 1-
    Details
    In: Journal of Medical Statistics and Informatics, Herbert Publications PVT LTD, Vol. 7, No. 1 ( 2019), p. 1-
    Type of Medium: Online Resource
    ISSN: 2053-7662
    URL: Article
    DOI: 10.7243/2053-7662-7-1
    Language: English
    Publisher: Herbert Publications PVT LTD
    Publication Date: 2019
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  • 8
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    Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg
    Springer Science and Business Media LLC ; 2010
    In:  BMC Pediatrics Vol. 10, No. 1 ( 2010-12)
    Details
    In: BMC Pediatrics, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2010-12)
    Type of Medium: Online Resource
    ISSN: 1471-2431
    URL: Article
    DOI: 10.1186/1471-2431-10-30
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2010
    detail.hit.zdb_id: 2041342-7
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  • 9
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    A review of multistate modelling approaches in monitoring disease progression: Bayesian estimation using the Kolmogorov-Chapman forward equations
    SAGE Publications ; 2021
    In:  Statistical Methods in Medical Research Vol. 30, No. 5 ( 2021-05), p. 1373-1392
    Details
    In: Statistical Methods in Medical Research, SAGE Publications, Vol. 30, No. 5 ( 2021-05), p. 1373-1392
    Abstract: There are numerous fields of science in which multistate models are used, including biomedical research and health economics. In biomedical studies, these stochastic continuous-time models are used to describe the time-to-event life history of an individual through a flexible framework for longitudinal data. The multistate framework can describe more than one possible time-to-event outcome for a single individual. The standard estimation quantities in multistate models are transition probabilities and transition rates which can be mapped through the Kolmogorov-Chapman forward equations from the Bayesian estimation perspective. Most multistate models assume the Markov property and time homogeneity; however, if these assumptions are violated, an extension to non-Markovian and time-varying transition rates is possible. This manuscript extends reviews in various types of multistate models, assumptions, methods of estimation and data features compatible with fitting multistate models. We highlight the contrast between the frequentist (maximum likelihood estimation) and the Bayesian estimation approaches in the multistate modeling framework and point out where the latter is advantageous. A partially observed and aggregated dataset from the Zimbabwe national ART program was used to illustrate the use of Kolmogorov-Chapman forward equations. The transition rates from a three-stage reversible multistate model based on viral load measurements in WinBUGS were reported.
    Type of Medium: Online Resource
    ISSN: 0962-2802 , 1477-0334
    URL: Article
    DOI: 10.1177/0962280221997507
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2001539-2
    detail.hit.zdb_id: 1136948-6
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  • 10
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    Table_2.DOCX
    Frontiers Media SA ; 2022
    In:  Frontiers in Epidemiology Vol. 2 ( 2022-7-8)
    Details
    In: Frontiers in Epidemiology, Frontiers Media SA, Vol. 2 ( 2022-7-8)
    Abstract: Recurrent clinical malaria episodes due to Plasmodium falciparum parasite infection are common in endemic regions. With each infection, acquired immunity develops, making subsequent disease episodes less likely. To capture the effect of acquired immunity to malaria, it may be necessary to model recurrent clinical disease episodes jointly with P. falciparum parasitemia data. A joint model of longitudinal parasitemia and time-to-first clinical malaria episode (single-event joint model) may be inaccurate because acquired immunity is lost when subsequent episodes are excluded. This study's informativeness assessed whether joint modeling of recurrent clinical malaria episodes and parasitemia is more accurate than a single-event joint model where the subsequent episodes are ignored. Methods The single event joint model comprised Cox Proportional Hazards (PH) sub-model for time-to-first clinical malaria episode and Negative Binomial (NB) mixed-effects sub-model for the longitudinal parasitemia. The recurrent events joint model extends the survival sub-model to a Gamma shared frailty model to include all recurrent clinical episodes. The models were applied to cohort data from Malawi. Simulations were also conducted to assess the performance of the model under different conditions. Results The recurrent events joint model, which yielded higher hazard ratios of clinical malaria, was more precise and in most cases produced smaller standard errors than the single-event joint model; hazard ratio (HR) = 1.42, [95% confidence interval [CI]: 1.22, 2.03] vs. HR = 1.29, [95% CI:1.60, 2.45] among participants who reported not to use LLINs every night compared to those who used the nets every night; HR = 0.96, [ 95% CI: 0.94, 0.98] vs. HR = 0.81, [95% CI: 0.75, 0.88] for each 1-year increase in participants' age; and HR = 1.36, [95% CI: 1.05, 1.75] vs. HR = 1.10, [95% CI: 0.83, 4.11] for observations during the rainy season compared to the dry season. Conclusion The recurrent events joint model in this study provides a way of estimating the risk of recurrent clinical malaria in a cohort where the effect of immunity on malaria disease acquired due to P. falciparum parasitemia with aging is captured. The simulation study has shown that if correctly specified, the recurrent events joint model can give risk estimates with low bias.
    Type of Medium: Online Resource
    ISSN: 2674-1199
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fepid.2022.924783
    DOI: 10.3389/fepid.2022.924783.s001
    DOI: 10.3389/fepid.2022.924783.s002
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 3106325-1
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