An evaluation of collaboration in the TB and HIV control programme in Oromia Region, Ethiopia: Seven years of retrospective data.

BACKGROUND: Globally, HIV and tuberculosis (TB) are a leading cause of death if they occur as co-morbidities in affected individuals. The aim of this study was to evaluate the collaboration between TB and HIV control activities by determining the co-morbidity rate in Oromia Region, Ethiopia, during the period 2009-2015. METHODS: A retrospective health facility-based study was conducted. Data were collected from health facilities implementing the directly observed treatment short-course (DOTS) strategy in the region. A structured World Health Organization (WHO) reporting format was used as the data collection tool. Pre-antiretroviral therapy (ART)/voluntary counselling and testing for HIV (VCT) and TB unit registers were considered as the data sources. Data were collected quarterly and analyzed using IBM SPSS Statistics version 20. The odds ratio was used to assess statistical differences among variables. RESULTS: A total of 115268 TB patients were counselled and tested for HIV during the study period. Among the patients tested, 60086 (52.1%) were male, of whom 13680 (11.8%) were found to have an HIV infection. Among TB patients who were co-infected with HIV, there were slightly higher odds of HIV infection in females than in males (odds ratio 1.13, 95% confidence interval 1.09-1.17). Between 2009 and 2013, about 56% of TB and HIV co-morbid patients were put on co-trimoxazole preventive therapy (CPT) and 35% on ART. HIV infection occurred predominantly within the age group of 25-34 years (31%). On the other hand, 197152 HIV-infected patients were screened for TB symptoms and 8.4% were found to have active TB. The odds of having TB among males who were initially infected with HIV were higher as compared to females (odds ratio 1.31, 95% confidence interval 1.27-1.37). CONCLUSIONS: The prevalence of TB and HIV co-morbidity was 11.8% at TB clinics in the region. Low proportions of co-infected patients were put on CPT and ART. Therefore, it is essential to strengthen the WHO recommended TB and HIV collaborative activities in the region to reduce the burden of co-morbidity and mortality.

Leveraging long acting reversible contraceptives to achieve FP2020 commitments in sub-Saharan Africa: The potential of implants.

BACKGROUND: In developing regions, an estimated 214 million women have an unmet need for family planning. Reaching Family Planning 2020 (FP2020) commitments will require a shift in modern contraceptive promotion, including improved access to long-acting reversible contraceptives (LARCs). Until now, a lack of market data limited understanding of the potential of LARCs to increase contraceptive access and choice. METHODS: From 2015, the FPwatch Project conducted representative surveys in Ethiopia, Nigeria, and Democratic Republic of Congo (DRC) using a full census approach in selected administrative areas. In these areas, every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, market share, availability, price, and outlet readiness to perform services. RESULTS: Fifty-four percent of outlets in Ethiopia had LARC commodities or services available at the time of the survey, versus 7% and 8% of outlets in Nigeria and DRC, respectively. When present, LARCs were usually available with at least two other methods (99%, 39%, and 84% of public health facilities in Ethiopia, Nigeria and DRC, respectively). Many public facilities had both implants and IUDs in stock (76%, 47%, and 53%, respectively). Lack of readiness to provide LARCs was mostly due to a lack of equipment, private room, or the commodity itself. Market share for implants in the public sector was 60%, 53%, and 37% of Couple Years of Protection (CYP) in Ethiopia, Nigeria, and DRC. DISCUSSION: Limited availability of LARCs in Nigeria and DRC restricts contraceptive choice and makes it difficult for women to adopt and use modern contraception consistently. Brand-specific subsidies, task shifting, and promotion of methods that require less equipment and training are promising strategies for increasing uptake. Substantial government investment is required to improve availability and affordability. Investment in implants should be prioritized to make progress towards FP2020 commitments.