scholarly journals “Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

2020 ◽  
Author(s):  
Tadele Girum ◽  
Fedila Yasin ◽  
Samuel Dessu ◽  
Bereket Zeleke ◽  
Mulugeta Geremew
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Density ◽  
South Ethiopia ◽  
Test And Treat ◽  
Universal Test ◽  
Universal Test And Treat ◽  
Adjusted Incidence

Abstract Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV and at least 25% of deaths are attributed to TB. Many countries implement the Universal Test and Treat (UTT) program for HIV, which is believed to reduce the incidence of TB. However, there are limited studies that evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment” programs, we aim to measure the effect of the UTT program on TB incidence.Objective: To measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage Zone, South Ethiopia.Methods: A retrospective cohort study was conducted through record review over 5 years (2014-2019) in public health facilities in Gurage Zone. 384 records were randomly selected and reviewed using a standardized structured checklist. Data was entered using Epi InfoTM Version 7 and analyzed by STATA. A generalized linear model with binomial link function was fitted to measure the adjusted incidence density/incidence rate ratio and to identify predictors of incidence difference between the two programs.Results: During the follow up period, 39 incident TB cases were identified with an overall incidence rate of 4.79/100 person-year (PY). TB incidence was significantly lower in the UTT cohort (IR=2.10/100 PY) in comparison to the differed program cohort (IR=6.23/100 PY). The adjusted incidence rate ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI=0.08-0.70). Thus, there was a reduction of TB incidence by 75% in the UTT program compared to differed program. In addition, IPT (isoniazid preventive therapy) use (AIRR= 0.35 (95% CI=0.22-0.48)), WHO Stage I and II (AIRR=0.70 (95% CI=0.61-0.94)) and higher base line CD4 count (AIRR=0.96 (95% CI=.94-0.99)) significantly reduced the incidence of TB. However, treatment failure increase the incidence (AIRR=5.8 (95% CI=1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

scholarly journals “Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

2020 ◽  
Author(s):  
Tadele Girum ◽  
Fedila Yasin ◽  
Samuel Dessu ◽  
Bereket Zeleke ◽  
Mulugeta Geremew
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Density ◽  
South Ethiopia ◽  
Test And Treat ◽  
Universal Test ◽  
Universal Test And Treat ◽  
Adjusted Incidence

Abstract Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV. At least 25% of deaths are attributed to TB. It is believed that, Universal test and treat (UTT) program for HIV reduces incidence of TB and most countries implement the program. However, there is limited study conducted to evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment” programs we aimed to measure the effect of the UTT program on incidence of TB.Objective: To measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia.Methods: Health facility based retrospective cohort study through record review of 5 year (2014-2019) cohort was conducted in public facilities of Gurage Zone. Randomly selected 384 records were reviewed by using standardized structured checklist. Data was entered by Epi info version 7 and analyzed by STATA. Generalized Linear Model with binomial link function was fitted to measure adjusted incidence density/Incidence rate ratio and identify predictors of incidence difference between the two programs.Results: During the follow up period, 39 incident TB cases were occurred, and making the overall incidence rate of 4.79/100 person-year (PY). It is significantly lower in the UTT (IR=2.10/100 PY) than the differed program (IR=6.23/100 PY). The adjusted Incidence Rate Ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI=0.08-0.70) compared to patients enrolled in the differed program. Thus, UTT program reduce TB incidence by 75% compared to differed program. In addition to the program, IPT (isoniazid preventive therapy) use (AIRR= 0.35 (95% CI=0.22-0.48)), WHO Stage I and II (AIRR=0.70 (95% CI=0.61-0.94)) and higher Base line CD4 count (AIRR=0.96 (95% CI=.94-0.99)) significantly reduce incidence of TB. Whereas, treatment failure increase the incidence (AIRR=5.8 (95% CI=1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

scholarly journals “Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

2020 ◽  
Author(s):  
Tadele Girum ◽  
Fedila Yasin ◽  
Samuel Dessu ◽  
Bereket Zeleke ◽  
Mulugeta Geremew
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Incidence Density ◽  
South Ethiopia ◽  
Test And Treat ◽  
Universal Test ◽  
Universal Test And Treat ◽  
Adjusted Incidence

Abstract Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV. At least twenty five percent of deaths are attributed to TB. It is believed that, Universal test and treat (UTT) program for HIV reduces incidence of TB and most countries implement the program. However, there is no study conducted to evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment/CD4 based” programs we aimed to measure the effect of the UTT program on incidence of TB. Objective: To measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia. Methods: Health facility based retrospective cohort study through record review of 5 year (2014-2019) cohort was conducted in public facilities of Gurage Zone. Randomly selected 384 records were reviewed by using standardized structured checklist by trained professionals. Data was entered by Epi info version 7 and analyzed by STATA. Generalized Linear Model with binomial link function was fitted to measure adjusted incidence density/Incidence rate ratio and identify predictors of incidence difference between the two programs. Results: During the follow up period, 39 incident TB cases were occurred, and making the overall incidence rate of 4.79/100 person-year. It is significantly lower in the UTT (IR=2.10/100 person-year) than the differed program (IR=6.23/100 person-year). The adjusted Incidence Rate Ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI=0.08-0.70) compared to patients enrolled in the differed program. Thus, UTT program reduce TB incidence by 75%. In addition to the program, IPT use (AIRR= 0.35 (95% CI=0.22-0.48)), WHO Stage I and II (AIRR=0.70 (95% CI=0.61-0.94)) and higher Base line CD4 count (AIRR=0.96 (95% CI=.94-0.99)) significantly reduce incidence of TB. Whereas, treatment failure increase the incidence (AIRR=5.8 (95% CI=1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

2021 ◽  
Author(s):  
Susanna Scharrer ◽  
Christian Primas ◽  
Sabine Eichinger ◽  
Sebastian Tonko ◽  
Maximilian Kutschera ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Fatal Bleeding ◽  
Adjusted Incidence Rate ◽  
Inflammatory Bowel ◽  
Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

Antiretroviral therapy adherence among patients enrolled after the initiation of the Universal Test and Treat strategy in Dessie town: a cross-sectional study

2020 ◽  
Vol 31 (9) ◽  
pp. 886-893
Author(s):  
Yitayish Damtie ◽  
Fentaw Tadese
Keyword(s):  
Antiretroviral Therapy ◽  
Cross Sectional Study ◽  
Poor Adherence ◽  
Art Adherence ◽  
Sectional Study ◽  
Cross Sectional ◽  
Test And Treat ◽  
Universal Test ◽  
Universal Test And Treat ◽  
Morisky Scale

Poor adherence was the major challenge in providing treatment, care, and support for people living with HIV (PLHIV). Evidence of adherence to antiretroviral therapy (ART) after initiation of the Universal Test and Treat (UTT) strategy was limited in Ethiopia. So, this study aimed to determine the proportion of ART adherence after the initiation of UTT strategy and associated factors among adult PLHIV in Dessie town using two adherence measurements. A cross-sectional study was conducted on 293 PLHIV selected using a systematic sampling technique. The data were collected by face-to face-interview using a pretested questionnaire; chart review was also used to collect the data. The proportion of ART adherence measured by using the Morisky scale and seven-day recall was 49.3% (95% CI: [43.5%, 54.8%]) and 95.9% (95% CI: [93.2%, 98.2%]), respectively. Being urban in residence (AOR = 3.72, 95% CI: [1.80, 7.68]), the absence of depression (adjusted odds ratio [AOR] = 3.72, 95% CI: [1.22, 11.35]), taking one tablet per day (AOR = 3.26, 95% CI: [1.64, 6.49]), and the absence of concomitant illness (AOR = 0.23, 95% CI: [0.09, 0.59]) were factors associated with ART adherence. The proportion of ART adherence measured by the Morisky scale was very low; however, adherence measured by seven-day recall was higher and consistent with World Health Organization recommendations. Residence, depression, and the number of tablets taken per day had a positive association with good ART adherence whereas having concomitant illness had a negative association with good ART adherence. Efforts should be made to improve adherence and interventions should be given to overcome factors linked with poor adherence.

Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study

2021 ◽  
pp. 1-11
Author(s):  
Benjamin T. Schumacher ◽  
John Bellettiere ◽  
Michael J. LaMonte ◽  
Kelly R. Evenson ◽  
Chongzhi Di ◽  
...  
Keyword(s):  
Physical Function ◽  
Older Women ◽  
Incidence Rate ◽  
Fall Risk ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Steps Per Day ◽  
Falls In Older Adults ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63–97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

Thirteen-Year Trends in Cardiovascular Risk in Men and Women with Chronic Coronary Syndrome

2021 ◽  
Author(s):  
Kevin Kris Warnakula Olesen ◽  
Esben Skov Jensen ◽  
Christine Gyldenkerne ◽  
Morten Würtz ◽  
Martin Bødtker Mortensen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Incidence Rate ◽  
Cardiac Death ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Men And Women ◽  
Coronary Syndrome ◽  
Adjusted Incidence Rate ◽  
Artery Disease ◽  
Adjusted Incidence

Abstract Aims To examine combined and sex-specific temporal changes in risks of adverse cardiovascular events and coronary revascularization in patients with chronic coronary syndrome undergoing coronary angiography. Methods We included all patients with stable angina pectoris and coronary artery disease examined by coronary angiography in Western Denmark from 2004 to 2016. Patients were stratified by examination year interval: 2004-2006, 2007-2009, 2010-2012, and 2013-2016. Outcomes were two-year risk of myocardial infarction, ischemic stroke, cardiac death, and all-cause death estimated by adjusted incidence rate ratios using patients examined in 2004-2006 as reference. Results A total of 29,471 patients were included, of whom 70% were men. The two-year risk of myocardial infarction (2.8% versus 1.9%, adjusted incidence rate ratio 0.65, 95% CI 0.53-0.81), ischemic stroke (1.8% versus 1.1%, adjusted incidence rate ratio 0.48, 95% CI 0.37-0.64), cardiac death (2.1% versus 0.9%, adjusted incidence rate ratio 0.38, 95% CI 0.29-0.51), and all-cause death (5.0% versus 3.6%, adjusted incidence rate ratio 0.65, 95% CI 0.55-0.76) decreased from the first examination interval (2004-2006) to the last examination interval (2013-2016). Coronary revascularizations also decreased (percutaneous coronary intervention: 51.6% versus 42.5%; coronary artery bypass grafting: 24.6% versus 17.5%). Risk reductions were observed in both men and women, however, women had a lower absolute risk. Conclusion The risk for adverse cardiovascular events decreased substantially in both men and women with chronic coronary syndrome from 2004 to 2016. These results most likely reflect the cumulative effect of improvements in the management of chronic coronary artery disease.

Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry

2019 ◽  
Vol 20 (11) ◽  
pp. 1271-1278 ◽  
Author(s):  
Kevin K W Olesen ◽  
Anders H Riis ◽  
Lene H Nielsen ◽  
Flemming H Steffensen ◽  
Bjarne L Nørgaard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Cardiac Computed Tomography ◽  
Adjusted Incidence Rate ◽  
Artery Disease ◽  
Event Rates ◽  
Adjusted Incidence ◽  
Diabetes Patients

Abstract Aims We examined whether severity of coronary artery disease (CAD) measured by coronary computed tomography angiography can be used to predict rates of myocardial infarction (MI) and death in patients with and without diabetes. Methods and results A cohort study of consecutive patients (n = 48 731) registered in the Western Denmark Cardiac Computed Tomography Registry from 2008 to 2016. Patients were stratified by diabetes status and CAD severity (no, non-obstructive, or obstructive). Endpoints were MI and death. Event rates per 1000 person-years, unadjusted and adjusted incidence rate ratios were computed. Median follow-up was 3.6 years. Among non-diabetes patients, MI event rates per 1000 person-years were 1.4 for no CAD, 4.1 for non-obstructive CAD, and 9.1 for obstructive CAD. Among diabetes patients, the corresponding rates were 2.1 for no CAD, 4.8 for non-obstructive CAD, and 12.6 for obstructive CAD. Non-diabetes and diabetes patients without CAD had similar low rates of MI [adjusted incidence rate ratio 1.40, 95% confidence interval (CI): 0.71–2.78]. Among diabetes patients, the adjusted risk of MI increased with severity of CAD (no CAD: reference; non-obstructive CAD: adjusted incidence rate ratio 1.71, 95% CI: 0.79–3.68; obstructive CAD: adjusted incidence rate ratio 4.42, 95% CI: 2.14–9.17). Diabetes patients had higher death rates than non-diabetes patients, irrespective of CAD severity. Conclusion In patients without CAD, diabetes patients have a low risk of MI similar to non-diabetes patients. Further, MI rates increase with CAD severity in both diabetes and non-diabetes patients; with diabetes patients with obstructive CAD having the highest risk of MI.

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