RESUMO
Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) infections have been identified to form a deadly synergy that is posing serious threats to human health and economic development particularly in Sub-Saharan Africa (SSA). Six years into the end TB strategy, it is imperative to assess HIV detection rate among TB patients in order to determine the prevalence as well as establish the temporal trend of the co-morbidity in the Eastern region of Ghana where the magnitude of HIV and TB/HIV co-morbidity have consistently been noted to be high. The study reviewed records of 840 TB patients retrospectively from January 1, 2009 to December 31, 2018 in Suhum Municipal. Socio-demographic characteristics and clinical data of study participants were extracted from the Municipal TB registers using an excel spread sheet. Data were exported into STATA version 16.0 for analysis with statistical significance set at p-value ≤0.05. Of the 840 TB patients, 793 (94.4%) were screened for HIV, with 18.6% (95% CI: 0.16-0.21) yielding positive results. A sharp increase in the trend of the co-infection was observed from 6 (14.6%) in 2009 to 21 (36.8%) in 2010. The highest (40.4%) co-infection prevalence was recorded in 2011. The study recorded an overall decreasing trend of the co-infection. Case detection rate for HIV among persons living with TB was high. TB/HIV co-infection rate in Suhum Municipal is high and occurs more often among females and persons aged 30 years to 49 years. A fairly stable prevalence trend of TB/HIV co-infection rate was also identified. In conclusion, ongoing integrated TB/HIV activities are showing good results and therefore need to be sustained.
RESUMO
BACKGROUND: The World Health Organization recommended the Test, Treat and Track (T3) strategy for malaria control that, every suspected malaria case should be tested prior to treatment with Artemisinin-based combination therapy (ACT) and tracked. We assessed the performance and challenges in the implementation of T3 strategy among children under-five years in Volta and Oti Regions of Ghana. METHOD: A descriptive cross-sectional study was carried in 69 health facilities. Exit interviews were conducted for caregivers of children with fever using a semi-structured questionnaire. Clinicians were interviewed at the out-patient department in each facility. Descriptive statistics was conducted, Chi-square test and logistic regression were used to determine the associations between completion of T3 and independent variables. RESULTS: Most children, 818/900 (90.9%) were tested for malaria and 600/818 (73.4%) were positive for malaria parasitaemia using rapid diagnostic test. Of those testing positive for malaria, 530/600 (88.3%) received treatment with ACTs. Half, (109/218) of the children testing negative for malaria also received ACTs. Also, 67/82 (81.7%) of children not tested for malaria received ACTs. Only 408/900 (45.3%) children completed T3 with Community Health-based Planning Services (CHPS) compound having the highest completion rate 202/314 (64.3%). CHPS Compounds were 6.55 times more likely to complete T3 compared to the hospitals [(95% CI: 3.77, 11.35), p<0.001]. Health facilities with laboratory services were 2.08 times more likely to complete T3 [(95% CI: 1.55, 2.79), p<0.001] The main challenge identified was clinicians' perception that RDTs do not give accurate results. CONCLUSION: Testing fever cases for malaria before treatment and treating positive cases with ACTs was high. Treating negative cases and those not tested with ACTs was also high. Health facilities having laboratory services and facility being CHPS compounds were key predictors of completing T3. Clinician's not trusting RDT results can affect the T3 strategy in malaria control. Periodic training/monitoring is required to sustain adherence to the strategy.