Browsing by Author "Nhandu V"

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    Chest radiograph reading and recording system: evaluation in frontline clinicians in Zambia.
    (2016-Mar-23) Henostroza G; Harris JB; Kancheya N; Nhandu V; Besa S; Musopole R; Krüüner A; Chileshe C; Dunn IJ; Reid SE; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. germanh@uab.edu.; Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.; Prisons Health Services, Ministry of Home Affairs, Lusaka, Zambia.; Department of Medicine, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Radiology, University of British Columbia, Vancouver, Canada.; Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA. germanh@uab.edu.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: In Zambia the vast majority of chest radiographs (CXR) are read by clinical officers who have limited training and varied interpretation experience, meaning lower inter-rater reliability and limiting the usefulness of CXR as a diagnostic tool. In 2010-11, the Zambian Prison Service and Ministry of Health established TB and HIV screening programs in six prisons; screening included digital radiography for all participants. Using front-line clinicians we evaluated sensitivity, specificity and inter-rater agreement for digital CXR interpretation using the Chest Radiograph Reading and Recording System (CRRS). METHODS: Digital radiographs were selected from HIV-infected and uninfected inmates who participated in a TB and HIV screening program at two Zambian prisons. Two medical officers (MOs) and two clinical officers (COs) independently interpreted all CXRs. We calculated sensitivity and specificity of CXR interpretations compared to culture as the gold standard and evaluated inter-rater reliability using percent agreement and kappa coefficients. RESULTS: 571 CXRs were included in analyses. Sensitivity of the interpretation "any abnormality" ranged from 50-70 % depending on the reader and the patients' HIV status. In general, MO's had higher specificities than COs. Kappa coefficients for the ratings of "abnormalities consistent with TB" and "any abnormality" showed good agreement between MOs on HIV-uninfected CXRs and moderate agreement on HIV-infected CXRs whereas the COs demonstrated fair agreement in both categories, regardless of HIV status. CONCLUSIONS: Sensitivity, specificity and inter-rater agreement varied substantially between readers with different experience and training, however the medical officers who underwent formal CRRS training had more consistent interpretations.
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    Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries.
    (2014-Nov) Ballif M; Nhandu V; Wood R; Dusingize JC; Carter EJ; Cortes CP; McGowan CC; Diero L; Graber C; Renner L; Hawerlander D; Kiertiburanakul S; Du QT; Sterling TR; Egger M; Fenner L; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Centre Intégré de Recherches Biocliniques, Abidjan, Côte d'Ivoire.; United States Agency for International Development Academic Model Providing Access to Healthcare, Eldoret, Kenya.; Vanderbilt University School of Medicine, Nashville, Tennessee, USA.; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Children's Hospital, Ho Chi Minh City, Viet Nam.; Women's Equity in Access to Care & Treatment, Kigali, Rwanda.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; University of Ghana Medical School, Accra, Ghana.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; University of Chile School of Medicine, Santiago, Chile.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons. OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.