Cargando…
Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini
Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of tr...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021747/ https://www.ncbi.nlm.nih.gov/pubmed/36962173 http://dx.doi.org/10.1371/journal.pgph.0000217 |
_version_ | 1784908569088360448 |
---|---|
author | Hartsough, Kieran Teasdale, Chloe A. Shongwe, Siphesihle Geller, Amanda Pimentel De Gusmao, Eduarda Dlamini, Phumzile Mafukidze, Arnold Pasipamire, Munyaradzi Ao, Trong Ryan, Caroline Modi, Surbhi Abrams, Elaine J. Howard, Andrea A. |
author_facet | Hartsough, Kieran Teasdale, Chloe A. Shongwe, Siphesihle Geller, Amanda Pimentel De Gusmao, Eduarda Dlamini, Phumzile Mafukidze, Arnold Pasipamire, Munyaradzi Ao, Trong Ryan, Caroline Modi, Surbhi Abrams, Elaine J. Howard, Andrea A. |
author_sort | Hartsough, Kieran |
collection | PubMed |
description | Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates. |
format | Online Article Text |
id | pubmed-10021747 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-100217472023-03-17 Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini Hartsough, Kieran Teasdale, Chloe A. Shongwe, Siphesihle Geller, Amanda Pimentel De Gusmao, Eduarda Dlamini, Phumzile Mafukidze, Arnold Pasipamire, Munyaradzi Ao, Trong Ryan, Caroline Modi, Surbhi Abrams, Elaine J. Howard, Andrea A. PLOS Glob Public Health Research Article Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates. Public Library of Science 2022-04-20 /pmc/articles/PMC10021747/ /pubmed/36962173 http://dx.doi.org/10.1371/journal.pgph.0000217 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Hartsough, Kieran Teasdale, Chloe A. Shongwe, Siphesihle Geller, Amanda Pimentel De Gusmao, Eduarda Dlamini, Phumzile Mafukidze, Arnold Pasipamire, Munyaradzi Ao, Trong Ryan, Caroline Modi, Surbhi Abrams, Elaine J. Howard, Andrea A. Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini |
title | Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini |
title_full | Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini |
title_fullStr | Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini |
title_full_unstemmed | Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini |
title_short | Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini |
title_sort | enhanced integration of tb services in reproductive maternal newborn and child health (rmnch) settings in eswatini |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021747/ https://www.ncbi.nlm.nih.gov/pubmed/36962173 http://dx.doi.org/10.1371/journal.pgph.0000217 |
work_keys_str_mv | AT hartsoughkieran enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT teasdalechloea enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT shongwesiphesihle enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT gelleramanda enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT pimenteldegusmaoeduarda enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT dlaminiphumzile enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT mafukidzearnold enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT pasipamiremunyaradzi enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT aotrong enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT ryancaroline enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT modisurbhi enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT abramselainej enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini AT howardandreaa enhancedintegrationoftbservicesinreproductivematernalnewbornandchildhealthrmnchsettingsineswatini |