Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study.

BACKGROUND: The COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia. METHODS: We employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges. RESULTS: The number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public's fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic. CONCLUSIONS: The COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.

Triple Priority: TB/HIV Co-Infection and Treatment Outcomes among Key Populations in The Kyrgyz Republic: A National Cohort Study (2018-2022).

Background: Improving tuberculosis (TB) care in key populations is an operational research priority in the Kyrgyz Republic. Here, we describe the characteristics of TB/HIV co-infected individuals, their affiliations with key country-wide population groups, and their TB treatment outcomes. Methods: This was a cohort study using national programmatic data (2018-2022). The key population groups included people with increased exposure to TB, limited access to TB services, and increased risk of acquiring TB. Results: Among 693 individuals with TB/HIV co-infection, the majority (58%) of individuals were from two regions of the Kyrgyz Republic (Chui and Bishkek). Eighty-four percent (84%) individuals had one or more affiliations to eight key population groups, with 49% of the individuals affiliated to ≥2 groups and 92% of the individuals were on both antiretroviral treatment and cotrimoxazole preventive therapy. Overall, 406 (59%) of the individuals had successful outcomes and 287 (41%) of the individuals had unsuccessful outcomes. Unsuccessful outcomes increased from 36% (n-39) with TB/HIV alone to 47% (n-86) with affiliations to ≥3 key population groups (P-0.03). Unsuccessful outcomes were associated with co-morbidities (diabetes mellitus and hepatitis B/C), migration, alcohol use, and extrapulmonary TB. Conclusions: For a long time, people with TB/HIV co-infection have been recognized as a "double priority". Affiliation to key populations accentuates their status to "triple priority". We advocate for increased attention and equity towards these populations.

High level of infection prevention and control in surveyed hospitals in Colombia, 2021.

Objective: This study aimed to determine the performance of infection prevention and control (IPC) programs in eight core components in level 2 and level 3 hospitals across all provinces in Colombia. Methods: This cross-sectional study used self-assessed IPC performance data voluntarily reported by hospitals to the Ministry of Health and Social Protection during 2021. Each of the eight core components of the World Health Organization's checklist in the Infection Prevention and Control Assessment Framework contributes a maximum score of 100, and the overall IPC performance score is the sum of these component scores. IPC performance is graded according to the overall score as inadequate (0-200), basic (201-400), intermediate (401-600) or advanced (601-800). Results: Of the 441 level 2 and level 3 hospitals, 267 (61%) reported their IPC performance. The median (interquartile range [IQR]) overall IPC score was 672 (IQR: 578-715). Of the 267 hospitals reporting, 187 (70%) achieved an advanced level of IPC. The median overall IPC score was significantly higher in private hospitals (690, IQR: 598-725) than in public hospitals (629, IQR: 538-683) (P < 0.001). Among the core components, scores were highest for the category assessing IPC guidelines (median score: 97.5) and lowest for the category assessing workload, staffing and bed occupancy (median score: 70). Median overall IPC scores varied across the provinces (P < 0.001). Conclusions: This countrywide assessment showed that 70% of surveyed hospitals achieved a self-reported advanced level of IPC performance, which reflects progress in building health system resilience. Since only 61% of eligible hospitals participated, an important next step is to ensure the participation of all hospitals in future assessments.

Bloodstream infections and antibiotic resistance at a regional hospital, Colombia, 2019-2021.

Objectives: To assess antibiotic susceptibility of World Health Organization (WHO) priority bacteria (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae) in blood cultures at the Orinoquía regional hospital in Colombia. Methods: This was cross-sectional study using routine laboratory data for the period 2019-2021. Data on blood samples from patients suspected of a bloodstream infection were examined. We determined: the total number of blood cultures done and the proportion with culture yield; the characteristics of patients with priority bacteria; and the type of bacteria isolated and antibiotic resistance patterns. Results: Of 25 469 blood cultures done, 1628 (6%) yielded bacteria; 774 (48%) of these bacteria were WHO priority pathogens. Most of the priority bacteria isolated (558; 72%) were gram-negative and 216 (28%) were gram-positive organisms. Most patients with priority bacteria (666; 86%) were hospitalized in wards other than the intensive care unit, 427 (55%) were male, and 321 (42%) were ≥ 60 years of age. Of the 216 gram-positive bacteria isolated, 205 (95%) were Staphylococcus aureus. Of the 558 gram-negative priority bacteria isolated, the three most common were Escherichia coli (34%), Klebsiella pneumoniae (28%), and Acinetobacter baumannii (20%). The highest resistance of Staphylococcus aureus was to oxacillin (41%). For gram-negative bacteria, resistance to antibiotics ranged from 4% (amikacin) to 72% (ampicillin). Conclusions: Bacterial yield from blood cultures was low and could be improved. WHO priority bacteria were found in all hospital wards. This calls for rigorous infection prevention and control standards and continued surveillance of antibiotic resistance.

Bloodstream infections and antibiotic resistance at a regional hospital, Colombia, 2019-2021 / Infecciones del torrente sanguíneo y resistencia a los antibióticos en un hospital regional en Colombia, 2019-2021 / Infecções de corrente sanguínea e resistência a antibióticos em um hospital regional, Colômbia, 2019-2021

ABSTRACT Objectives. To assess antibiotic susceptibility of World Health Organization (WHO) priority bacteria (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae) in blood cultures at the Orinoquía regional hospital in Colombia. Methods. This was cross-sectional study using routine laboratory data for the period 2019-2021. Data on blood samples from patients suspected of a bloodstream infection were examined. We determined: the total number of blood cultures done and the proportion with culture yield; the characteristics of patients with priority bacteria; and the type of bacteria isolated and antibiotic resistance patterns. Results. Of 25 469 blood cultures done, 1628 (6%) yielded bacteria; 774 (48%) of these bacteria were WHO priority pathogens. Most of the priority bacteria isolated (558; 72%) were gram-negative and 216 (28%) were gram-positive organisms. Most patients with priority bacteria (666; 86%) were hospitalized in wards other than the intensive care unit, 427 (55%) were male, and 321 (42%) were ≥ 60 years of age. Of the 216 gram-positive bacteria isolated, 205 (95%) were Staphylococcus aureus. Of the 558 gram-negative priority bacteria isolated, the three most common were Escherichia coli (34%), Klebsiella pneumoniae (28%), and Acinetobacter baumannii (20%). The highest resistance of Staphylococcus aureus was to oxacillin (41%). For gram-negative bacteria, resistance to antibiotics ranged from 4% (amikacin) to 72% (ampicillin). Conclusions. Bacterial yield from blood cultures was low and could be improved. WHO priority bacteria were found in all hospital wards. This calls for rigorous infection prevention and control standards and continued surveillance of antibiotic resistance.

RESUMEN Objetivos. Evaluar la sensibilidad a los antibióticos de las bacterias incluidas en la lista prioritaria de la Organización Mundial de la Salud (OMS) (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus y Streptococcus pneumoniae) en hemocultivos en el Hospital Regional de la Orinoquía en Colombia. Métodos. Se trata de un estudio transversal que empleó datos rutinarios de laboratorio del período comprendido entre los años 2019 y 2021. Se examinaron datos de muestras de sangre de pacientes con presunción clínica de infección del torrente sanguíneo. Se determinó el número total de hemocultivos realizados y la proporción cultivos con resultados, las características de los pacientes con bacterias prioritarias, así como el tipo de bacterias aisladas y los patrones de resistencia a los antibióticos. Resultados. De 25 469 hemocultivos realizados, se aislaron bacterias en 1628 (6%); 774 (48%) con agentes patógenos prioritarios de la OMS. La mayoría de las cepas bacterianas prioritarias aisladas (558; 72%) eran gramnegativas y 216 (28%), organismos grampositivos. La mayoría de los pacientes con bacterias prioritarias (666; 86%) fueron hospitalizados en salas distintas de la unidad de cuidados intensivos, 427 (55%) eran varones y 321 (42%) tenían 60 años o más. De las 216 bacterias grampositivas aisladas, 205 (95%) eran Staphylococcus aureus. De las 558 bacterias prioritarias gramnegativas aisladas, las tres más comunes fueron Escherichia coli (34%), Klebsiella pneumoniae (28%) y Acinetobacter baumannii (20%). La mayor resistencia de Staphylococcus aureus fue a la oxacilina (41%). Entre las bacterias gramnegativas, la resistencia a los antibióticos varió del 4% (amikacina) al 72% (ampicilina). Conclusiones. El aislamiento de bacterias en los hemocultivos fue bajo y podría mejorarse. Se encontraron bacterias de la lista prioritaria de la OMS en todas las salas del hospital, por lo que es necesario aplicar rigurosas normas de prevención y control de infecciones y realizar una vigilancia continua de la resistencia a los antibióticos.

RESUMO Objetivos. Avaliar a suscetibilidade a antibióticos das bactérias consideradas prioritárias pela Organização Mundial da Saúde (OMS) (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus e Streptococcus pneumoniae) em hemoculturas coletadas no hospital regional de Orinoquía na Colômbia. Métodos. Estudo transversal utilizando dados laboratoriais de rotina do período 2019-2021. Foram examinados os dados de amostras de sangue de pacientes com suspeita de infecção de corrente sanguínea. Determinamos o número total de hemoculturas realizadas e a proporção de culturas com rendimento, as características dos pacientes com bactérias prioritárias, e o tipo de bactéria isolada e padrões de resistência a antibióticos. Resultados. Das 25.469 hemoculturas realizadas, 1.628 (6%) foram positivas para bactérias, sendo que 774 (48%) dessas bactérias eram da lista de agentes patogênicos prioritários da OMS. A maioria das bactérias prioritárias isoladas (558; 72%) eram gram-negativas e 216 (28%) eram gram-positivas. A maioria dos pacientes com bactérias prioritárias (666; 86%) estava internada em enfermaria, e não em unidade de terapia intensiva. 427 (55%) eram homens e 321 (42%) tinham ≥ 60 anos de idade. Das 216 bactérias gram-positivas isoladas, 205 (95%) eram Staphylococcus aureus. Das 558 bactérias gram-negativas prioritárias isoladas, as três mais frequentes foram Escherichia coli (34%), Klebsiella pneumoniae (28%) e Acinetobacter baumannii (20%). O Staphylococcus aureus apresentou maior resistência à oxacilina (41%). Entre as bactérias gram-negativas, a resistência aos antibióticos variou entre 4% (amicacina) e 72% (ampicilina). Conclusões. O rendimento bacteriano das hemoculturas foi baixo e pode ser melhorado. As bactérias consideradas prioritárias pela OMS foram encontradas em todas as enfermarias do hospital. Os achados exigem normas rigorosas de prevenção e controle de infecção, e vigilância contínua da resistência bacteriana a antibióticos.

High level of infection prevention and control in surveyed hospitals in Colombia, 2021 / Nivel avanzado de prevención y control de infecciones en hospitales de Colombia en el 2021 / Alto nível de prevenção e controle de infecções em hospitais da Colômbia, 2021

ABSTRACT Objective. This study aimed to determine the performance of infection prevention and control (IPC) programs in eight core components in level 2 and level 3 hospitals across all provinces in Colombia. Methods. This cross-sectional study used self-assessed IPC performance data voluntarily reported by hospitals to the Ministry of Health and Social Protection during 2021. Each of the eight core components of the World Health Organization's checklist in the Infection Prevention and Control Assessment Framework contributes a maximum score of 100, and the overall IPC performance score is the sum of these component scores. IPC performance is graded according to the overall score as inadequate (0-200), basic (201-400), intermediate (401-600) or advanced (601-800). Results. Of the 441 level 2 and level 3 hospitals, 267 (61%) reported their IPC performance. The median (interquartile range [IQR]) overall IPC score was 672 (IQR: 578-715). Of the 267 hospitals reporting, 187 (70%) achieved an advanced level of IPC. The median overall IPC score was significantly higher in private hospitals (690, IQR: 598-725) than in public hospitals (629, IQR: 538-683) (P < 0.001). Among the core components, scores were highest for the category assessing IPC guidelines (median score: 97.5) and lowest for the category assessing workload, staffing and bed occupancy (median score: 70). Median overall IPC scores varied across the provinces (P < 0.001). Conclusions. This countrywide assessment showed that 70% of surveyed hospitals achieved a self-reported advanced level of IPC performance, which reflects progress in building health system resilience. Since only 61% of eligible hospitals participated, an important next step is to ensure the participation of all hospitals in future assessments.

RESUMEN Objetivo. El objetivo de este estudio es determinar el desempeño de los programas de prevención y control de infecciones (PCI) en relación con ocho componentes básicos en hospitales de nivel 2 y 3 de todas las provincias de Colombia. Métodos. En este estudio transversal se emplearon datos de autoevaluación del desempeño de los programas de PCI informados voluntariamente al Ministerio de Salud y Protección Social por parte de los hospitales durante el 2021. Cada uno de los ocho componentes básicos de la lista de verificación de la Organización Mundial de la Salud incluidos en el Marco de evaluación de prevención y control de infecciones al nivel de establecimientos de atención de salud recibe una puntuación máxima de 100, y la puntuación general del desempeño del programa es la suma de las puntuaciones de estos componentes. Este desempeño se califica según la puntuación general como inadecuado (0-200), básico (201-400), intermedio (401-600) o avanzado (601-800). Resultados. De los 441 hospitales de nivel 2 y nivel 3, 267 (61%) informaron datos sobre su desempeño. La mediana (rango intercuartil [IQR]) de la puntuación general fue de 672 (IQR: 578-715). De los 267 hospitales que proporcionaron información, 187 (70%) alcanzaron el nivel avanzado. La mediana de la puntuación general fue significativamente mayor en los hospitales privados (690, IQR: 598-725) que en los hospitales públicos (629, IQR: 538-683) (p < 0,001). En el caso de los componentes básicos, las puntuaciones más altas fueron para la categoría que evalúa las directrices de PCI (puntuación mediana: 97,5) y más bajas para la categoría que evalúa la carga de trabajo, la dotación de personal y la ocupación de camas (puntuación mediana: 70). La mediana de las puntuaciones generales de PCI varió entre las provincias (p < 0,001). Conclusiones. Esta evaluación a nivel nacional mostró que el 70% de los hospitales encuestados lograron un nivel avanzado autoinformado del desempeño en cuanto a la PCI, lo que refleja el progreso en fortalecimiento de la resiliencia del sistema de salud. Dado que solo participó el 61% de los hospitales que reunían las condiciones, el siguiente paso importante es garantizar la participación de todos los hospitales en futuras evaluaciones.

RESUMO Objetivo. Este estudo teve o objetivo de determinar o desempenho de programas de prevenção e controle de infecções (PCI) quanto a oito componentes centrais em hospitais secundários e terciários de todas as províncias da Colômbia. Métodos. Este estudo transversal utilizou dados de desempenho autoavaliado de PCI enviados voluntariamente pelos hospitais ao Ministério da Saúde e Proteção Social em 2021. Cada um dos oito componentes centrais da lista de verificação na Estrutura de Avaliação de Prevenção e Controle de Infecções da Organização Mundial da Saúde contribui com uma pontuação máxima de 100. A pontuação total de desempenho de PCI é a soma das pontuações nesses componentes. De acordo com a pontuação total, o desempenho de PCI é classificado nas seguintes categorias: inadequado (0-200), básico (201-400), intermediário (401-600) ou avançado (601-800). Resultados. Dos 441 hospitais secundários e terciários, 267 (61%) informaram o desempenho de PCI. A mediana (intervalo interquartil [IIQ]) da pontuação total de PCI foi 672 (IIQ: 578-715). Dos 267 hospitais que disponibilizaram informações, 187 (70%) alcançaram um nível de PCI avançado. A mediana da pontuação total de PCI foi significativamente maior nos hospitais privados (690, IIQ: 598-725) do que nos públicos (629, IIQ: 538-683) (p < 0,001). Entre os componentes centrais, as pontuações mais altas foram observadas na categoria de avaliação das diretrizes de PCI (pontuação mediana: 97,5), ao passo que as mais baixas ocorreram na categoria de avaliação da carga de trabalho, dotação de pessoal e taxa de ocupação de leitos (pontuação mediana: 70). As medianas das pontuações totais de PCI variaram entre províncias (p < 0,001). Conclusões. Esta avaliação nacional mostrou que 70% dos hospitais pesquisados alcançaram um nível avançado de desempenho autorrelatado de PCI, o que demonstra progresso no desenvolvimento de resiliência no sistema de saúde. Como apenas 61% dos hospitais elegíveis participaram, um próximo passo importante é assegurar a participação de todos os hospitais em futuras avaliações.

Primary healthcare providers challenged during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers' experiences with coronavirus pandemic preparedness and response in Armenia. METHODS: We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the "SPSS22.0.0.0" software. RESULTS: Five main themes of primary healthcare providers' experiences were drawn out based on the study findings: 1) the gap in providers' risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers' experiences during the pandemic. The study highlighted the health systems' unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers' behalf. CONCLUSION: The study discovered that PHC providers have a very important role in healthcare system's preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment.

What Is in the Salad? Escherichia coli and Antibiotic Resistance in Lettuce Irrigated with Various Water Sources in Ghana.

INTRODUCTION: Safety of the environment in which vegetables are grown, marketed and consumed is paramount as most are eaten raw. Irrigation sources include open drains and streams, which are often contaminated with human and animal waste due to poor sanitation infrastructure. In irrigated vegetable farms using such sources in Ghana, we assessed Escherichia coli counts, antibiotic resistance patterns and resistant genes on irrigated lettuce. METHODS: A cross-sectional study was conducted between January-May 2022, involving five major vegetable farms in Ghana. RESULTS: Escherichia coli was found in all 25 composite lettuce samples analyzed. Counts expressed in CFU/g ranged from 186 to 3000, with the highest counts found in lettuce irrigated from open drains (1670) and tap water using hose pipes (3000). Among all bacterial isolates, resistance ranged between 49% and 70% for the Watch group of antibiotics, 59% for the Reserved group and 82% were multidrug-resistant. Of 125 isolates, 60 (48%) were extended-spectrum beta-lactamase-producing, of which five (8%) had the blaTEM-resistant gene. CONCLUSIONS: Lettuce was contaminated with Escherichia coli with high levels of antibiotic resistance. We call on the Ghana Ministry of Food and Agriculture, Food and Drugs Authority and other stakeholders to support farmers to implement measures for improving vegetable safety.

Quality, Equity and Partnerships in Mixed Methods and Qualitative Research during Seven Years of Implementing the Structured Operational Research and Training Initiative in 18 Countries.

Introduction: Qualitative studies are often inadequately reported, making it difficult to judge their appropriateness for decision making in public health. We assessed the publication characteristics and quality of reporting of qualitative and mixed-method studies from the Structured Operational Research and Training Initiative (SORT IT), a global partnership for operational research capacity building. Methods: A cross-sectional analysis of publications to assess the qualitative component using an adapted version of the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: In 67 publications involving 18 countries, 32 journals and 13 public health themes, 55 were mixed-methods studies and 12 were qualitative studies. First authorship from low-and-middle-income (LMIC) countries was present in 64 (96%), LMIC last authorship in 55 (82%), and female first authorship in 30 (45%). The mean LMIC institutions represented per publication was five (range 1-11). Sixty-three (94%) publications were open access. Reporting quality was graded as 'good' to 'excellent' in 60 (89%) publications, 'fair' in five (8%) and 'poor' in two (3%). Conclusion: Most SORT IT publications adhered to COREQ standards, while supporting gender equity in authorship and the promotion of LMIC research leadership. SORT IT plays an important role in ensuring quality of evidence for decision making to improve public health.

Performance of an Emergency Road Ambulance Service in Bhutan: Response Time, Utilization, and Outcomes.

Background: An efficient ambulance service is a vital component of emergency medical services. We determined the emergency ambulance response and transport times and ambulance exit outcomes in Bhutan. Methods: A cross-sectional study involving real-time monitoring of emergency ambulance deployments managed by a central toll-free (112) hotline (20 October 2021 to 20 January 2022) was carried out. Results: Of 5092 ambulance deployments, 4291 (84%) were inter-facility transfers, and 801 (16%) were for emergencies. Of the latter, 703 (88%) were for non-pregnancy-related emergencies (i.e., medical, surgical, and accidents), while 98 (12%) were for pregnancy-related emergencies. The median ambulance response and patient transport times were 42 (IQR 3-271) and 41 (IQR 2-272) minutes, respectively. The median round-trip distance travelled by ambulances was 18 km (range 1-186 km). For ambulance exit outcomes that were pregnancy-related (n = 98), 89 (91%) reached the health facility successfully, 8 delivered prior to ambulance arrival at the scene or in the ambulance during transport, and 1 had no outcome record. For the remaining 703 non-pregnancy deployments, 29 (4.1%) deployments were deemed not required or refusals, and 656 (93.3%) reached the health facility successfully; 16 (2.3%) died before the ambulance's arrival at the scene, and 2 (0.3%) were not recorded. Conclusions: This first countrywide real-time operational research showed acceptable ambulance exit outcomes. Improving ambulance response and transport times might reduce morbidities and mortalities further.

Achieving Minimum Standards for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the COVID-19 Era!

INTRODUCTION: Good Infection prevention and control (IPC) is vital for tackling antimicrobial resistance and limiting health care-associated infections. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. METHODS: Cross-sectional assessments using standardized World Health Organizations IPC checklists. IPC performance scores were graded as inadequate = 0-25%, basic = 25.1-50%, intermediate = 50.1-75%, and advanced = 75.1-100%. RESULTS: Overall performance improved from 'basic' to 'intermediate' at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained 'basic' at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined monitoring plan with clear goals, targets and activities. CONCLUSION: Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pandemic. There is urgent need to mobilize political will, leadership and resources and make a quantum leap forward.

Inconsistent Country-Wide Reporting of Adverse Drug Reactions to Antimicrobials in Sierra Leone (2017-2021): A Wake-Up Call to Improve Reporting.

Background: Monitoring of adverse drug reactions (ADRs) to antimicrobials is important, as they can cause life-threatening illness, permanent disabilities, and death. We assessed country-wide ADR reporting on antimicrobials and their outcomes. Methods: A cross-sectional study was conducted using individual case safety reports (ICSRs) entered into the national pharmacovigilance database (VigiFlow) during 2017−2021. Results: Of 566 ICSRs, inconsistent reporting was seen, with the highest reporting in 2017 and 2019 (mass drug campaigns for deworming), zero reporting in 2018 (reasons unknown), and only a handful in 2020 and 2021 (since COVID-19). Of 566 ICSRs, 90% were for antiparasitics (actively reported during mass campaigns), while the rest (passive reporting from health facilities) included 8% antibiotics, 7% antivirals, and 0.2% antifungals. In total, 90% of the reports took >30 days to be entered (median = 165; range 2−420 days), while 44% had <75% of all variables filled in (desired target = 100%). There were 10 serious ADRs, 18 drug withdrawals, and 60% of ADRs affected the gastrointestinal system. The patient outcomes (N-566) were: recovered (59.5%), recovering (35.5%), not recovered (1.4%), death (0.2%), and unknown (3.4%). There was no final ascertainment of 'recovering' outcomes. Conclusions: ADR reporting is inconsistent, with delays and incomplete data. This is a wake-up call for introducing active reporting and setting performance targets.

A five-year audit of gaps in HIV testing and associations with TB treatment outcomes in Armenia, 2015-2019.

INTRODUCTION: Poor human immunodeficiency virus (HIV) testing practices and underreporting of HIV-related data in TB information systems remain barriers to effective care for TB-HIV co-infected patients. HIV testing and recording practices in national TB program have not been formally evaluated in Armenia. This study aimed to assess the recording completeness of HIV testing and HIV status in the national TB program electronic database, and to determine trend in HIV testing and the association between HIV testing and treatment outcomes for all TB patients registered in Armenia (2015-2019). METHODOLOGY: A cohort study of TB patients using routine programmatic data from the national TB program of Armenia. RESULTS: From 2015 to 2019, the electronic database was completed for HIV testing and HIV status by 48.1% and 97.5%, respectively. Of all registered TB patients 93.6% were tested for HIV. Of a total 4,674 patients, 1,085 (23.2%) had unsuccessful outcomes. Patients with HIV status "not tested" and "not recorded" compared to HIV "negatives" had 1.76 (95%CI 1.42-2.11) and 1.6 (95%CI 1.20-2.06) times higher risk of unsuccessful outcomes, respectively. Lost to follow-up was the most frequent unsuccessful outcome in HIV status "not tested" group. CONCLUSIONS: An analysis of nationwide data revealed incompleteness of the national TB electronic database for HIV data. Patients with HIV status "not tested" and "not recorded" had higher risk of unsuccessful TB treatment outcomes. Upgrade of the electronic database with information on key indicators of TB-HIV services will facilitate improved monitoring and reporting.

Antiretroviral therapy among patients with HIV in Almaty, Kazakhstan: the implication for HIV-associated tuberculosis control.

INTRODUCTION: Antiretroviral therapy (ART) is an effective preventive strategy against tuberculosis (TB) in people living with HIV (PLWH). In Kazakhstan, according to the revised HIV treatment guideline (2017), ART should be initiated immediately after HIV diagnosis established, regardless of CD4+ count. AIM: To evaluate the impact of early initiation of ART on TB infection in PLWH registered in the Center of Prevention and Control of AIDS, Almaty, Kazakhstan, between 2008 and 2018. METHODOLOGY: A retrospective cohort study was conducted using the data of 4,053 patients from electronic HIV case management system (2008-2018) (EHCMS). RESULTS: The study revealed low rates (12.6%) of rapid ART (≤ 1 month after HIV diagnosis). Patients in the rapid ART initiation group were less likely to develop TB compared with those who started treatment >1 month after the HIV detection (odds ratio 1.6; 95% confidence interval [1.1, 2.2]; p = 0.00799). Interestingly, the risk for developing TB among patients receiving ART ≥ 1 month after HIV diagnosis was significantly higher compared with those not taking any treatment. The latter was explained by several confounding not addressed during the analysis, since ART was prescribed to patients with primarily deeper immunodeficiency, while the patients not receiving ART were less immunocompromised. CONCLUSION: Despite the recently changed HIV treatment guideline in Kazakhstan, ART is still initiated based on the disease severity. In 2018, the initiation of ART during the first month after HIV diagnosis increased by 50%. However, it is necessary to reduce the time to initiation of ART for all patients.