Sustaining tuberculosis preventive therapy scale-up through direct supportive supervision.

BACKGROUND: Tuberculosis preventive therapy (TPT) is recommended for tuberculosis (TB) prevention among people living with HIV (PLHIV) and other high-risk groups. The Nigerian Military HIV Program embarked on TPT-specific 'direct supportive supervision' (DSS) in May 2018 to increase TPT initiation and completion rates. METHODS: Interventional approaches included site visits to conduct root cause analysis, didactic teaching approach on the concepts of quality improvement and mentorship to address barriers. The DSS introduced TPT monitoring tools, sticker reminders on clients' folders, and bi-weekly data collection and review for decision making. RESULTS: TPT initiation increased from a monthly pre-intervention median of 323 clients to monthly medians of 2611 during the 'surge' and 1212 clients during the 'sustained' phases. Due to an isoniazid stock-out, a 'dip phase', with a median of 559 clients was recorded. Overall, 10 463 clients were started on TPT in fiscal year (FY) 2018 and 12 596 in FY2019, with an overall initiation rate of 79%. Completion rates were respectively 73% and 70% for FY2018 and FY2019. CONCLUSION: With the implementation of a tailored DSS, programmatic barriers to TPT were easily identified and quickly addressed to increase initiation and completion rates.

CONTEXTE: Le traitement préventif de la tuberculose (TPT) est recommandé pour la prévention de la tuberculose (TB) parmi les personnes vivant avec le VIH (PVVIH) et pour d'autres groupes à risque élevé. Le programme VIH de l'armée au Nigeria a rencontré de nombreux défis dans sa mise en œuvre. MÉTHODE: En mai 2018, le programme s'est lancé dans une « supervision directe de soutien ¼ spécifique du TPI (DSS) en vue de son expansion et de la réduction de la transmission de la TB chez les PVVIH. Les approches d'intervention mises en œuvre ont inclus des visites sur le terrain afin d'analyser les causes profondes, une approche didactique d'enseignement relatif aux concepts d'amélioration de la qualité et un tutorat afin de surmonter les obstacles. On a eu recours à l'introduction d'un outil de suivi du TPT, à des rappels sous forme de stickers sur les dossiers des clients et à un recueil de données et à une revue destinée à la prise de décisions bi hebdomadaire. RÉSULTATS: La mise en route du TPT a augmenté d'une médiane mensuelle avant l'intervention de 323 clients à 2611 et 1212 clients pendant les phases de lancement et de continuation respectivement. En raison d'une rupture de stock d'isoniazide, une phase de chute avec une médiane de 559 clients a été enregistrée. Au total, 10 463 et 12 596 clients ont débuté le TPT en FY2018 et FY2019 respectivement, avec un taux d'ensemble d'initiation de 79%. Les taux d'achèvement ont été de 73% et 70% respectivement pour FY2018 et FY2019. CONCLUSION: Grâce à une stratégie sur mesure de supervision et de soutien et en tenant compte des contextes particuliers du terrain, les obstacles programmatiques à la mise en œuvre du TPI ont été facilement identifiés et rapidement affrontés pour une meilleure prise en charge du patient.

Improving indicators of tuberculosis program cascades by leveraging HIV program strategies.

BACKGROUND: To improve rates of human immunodeficiency virus (HIV) case detection and treatment, the Nigerian Ministry of Defense Health Implementation Program and the US Army Medical Research Directorate-Africa/Nigeria introduced a HIV standard of care (SOC) package. Given the integration of tuberculosis (TB) and HIV programs and evolving policies, we evaluated the impact of this strategy on TB program indicators. METHODS: Routine, de-identified program data from 27 Nigerian military hospitals were analyzed. Using Wilcoxon signed-rank test, bivariate analyses were performed to compare data from 12 months before and after implementation of the SOC package. RESULTS: Our data showed improvements post-implementation as follows: the number of individuals receiving antiretroviral therapy (ART) screened for TB increased from 14 530 to 29 467 (P < 0.001); the number of individuals with presumptive TB identified increased from 803 to 1800 (P < 0.001); the number of ART clients bacteriologically tested for TB increased from 746 to 1717 (P < 0.001); and the number of ART clients treated for TB increased from 152 to 282 (P < 0.001). Newly registered or relapsed TB cases increased from 436 to 906 (P < 0.001), the number of TB cases with known HIV status increased from 437 to 837 (P < 0.001), the number of TB-HIV co-infected cases increased from 182 to 301 (P = 0.006), and the number of TB-HIV co-infected clients who started ART increased from 101 to 176 (P = 0.003). CONCLUSION: The implementation of the updated HIV SOC package led to the improvement in key TB diagnosis and treatment indicators. When emulated, this could help improve the performance of other TB programs in countries other than Nigeria.

A detailed RFLP map of Sorghum bicolor x S. propinquum, suitable for high-density mapping, suggests ancestral duplication of Sorghum chromosomes or chromosomal segments.

The first "complete" genetic linkage map of Sorghum section Sorghum is described, comprised of ten linkage groups putatively corresponding to the ten gametic chromosomes of S. bicolor and S. propinquum. The map includes 276 RFLP loci, predominately detected by PstI-digested S. bicolor genomic probes, segregating in 56 F2 progeny of a cross between S. bicolor and S. propinquum. Although prior cytological evidence suggests that the genomes of these species are largely homosequential, a high level of molecular divergence is evidenced by the abundant RFLP and RAPD polymorphisms, the marked deviations from Mendelian segregation in many regions of the genome, and several species-specific DNA probes. The remarkable level of DNA polymorphism between these species will facilitate development of a high-density genetic map. Further, the high level of DNA polymorphism permitted mapping of multiple loci for 21 (8.2%) DNA probes. Linkage relationships among eight (38%) of these probes suggest ancestral duplication of three genomic regions. Mapping of 13 maize genomic clones in this cross was consistent with prior results. Mapping of heterologous cDNAs from rice and oat suggests that it may be feasible to extend comparative mapping to these distantly-related species, and to ultimately generate a detailed description of chromosome rearrangements among cultivated Gramineae. Limited investigation of a small number of RFLPs showed several alleles common to S. bicolor and S. Halepense ("johnson-grass"), but few alleles common to S. propinquum and S. halepense, raising questions about the origin of S. halepense.

Characterization of the region containing the jcpk PKD gene on mouse Chromosome 10.

The jcpk gene on mouse Chromosome 10 causes a severe, early onset form of polycystic kidney disease (PKD) when inherited in an autosomal recessive manner. In order to positionally clone this gene, high resolution genetic and radiation hybrid maps were generated along with a detailed physical map of the approximately 500-kb region containing the jcpk gene. Additionally, sixty-nine kidney-specific ESTs were evaluated as candidates for jcpk and subsequently localized throughout the mouse genome by radiation hybrid mapping analysis. Previous studies indicating non-complementation of the jcpk mutation and 67Gso, a new PKD translocation mutant had suggested that 67Gso represents a new allele of jcpk. Fluorescence in situ hybridization (FISH) analysis using key bacterial artificial chromosome clones from the jcpk critical region, refined the 67Gso breakpoint and provided support for the allelism of jcpk and 67Gso.