Implementation of Management of Pulmonary Tuberculosis with the Directly Observed Treatment Short course Strategy

The purpose of this study was to describe the implementation of pulmonary TB disease management with the DOTS strategy at the Jagong Health Center, Central Aceh Regency.The implementation of Pulmonary TB Management with the DOTS (Directly Observed Treatment Shortcourse) strategy in the working area of the Jagong Health Center, Central Aceh Regency has been maximized. by facilitating and providing motivation so that patients want treatment in a complete and integrated manner, case detection can be carried out by health workers or cadres who have been given training to recognize the symptoms of pulmonary TB. The distribution of drugs is distributed to each puskesmas in Central Aceh Regency, from the Puskesmas the drugs are arranged directly by P2TB officers then given directly to the PMO or the patient himself. PMO performance has never been given special training about treatment, PMO only received direction from P2TB Pulmonary officers. Recording and reporting carried out at the Jagong Health Center includes case finding, treatment, and recovery. Suspected pulmonary TB will be recorded and then monitored until the results of the examination have been obtained. Recording and reporting will be reported every month in a meeting at the Central Aceh District Health Office. For the Central Aceh Regency government to further enhance the development and improvement of infrastructure in the health sector so that health services are more easily accessible to people in remote areas.

Prediction Models for Future High-Need High-Cost Healthcare Use: a Systematic Review

Background In an effort to improve both quality of care and cost-effectiveness, various care-management programmes have been developed for high-need high-cost (HNHC) patients. Early identification of patients at risk of becoming HNHC (i.e. case finding) is crucial to a programme’s success. We aim to systematically identify prediction models predicting future HNHC healthcare use in adults, to describe their predictive performance and to assess their applicability. Methods Ovid MEDLINE® All, EMBASE, CINAHL, Web of Science and Google Scholar were systematically searched from inception through January 31, 2021. Risk of bias and methodological quality assessment was performed through the Prediction model Risk Of Bias Assessment Tool (PROBAST). Results Of 5890 studies, 60 studies met inclusion criteria. Within these studies, 313 unique models were presented using a median development cohort size of 20,248 patients (IQR 5601–174,242). Predictors were derived from a combination of data sources, most often claims data (n = 37; 62%) and patient survey data (n = 29; 48%). Most studies (n = 36; 60%) estimated patients’ risk to become part of some top percentage of the cost distribution (top-1–20%) within a mean time horizon of 16 months (range 12–60). Five studies (8%) predicted HNHC persistence over multiple years. Model validation was performed in 45 studies (76%). Model performance in terms of both calibration and discrimination was reported in 14 studies (23%). Overall risk of bias was rated as ‘high’ in 40 studies (67%), mostly due to a ‘high’ risk of bias in the subdomain ‘Analysis’ (n = 37; 62%). Discussion This is the first systematic review (PROSPERO CRD42020164734) of non-proprietary prognostic models predicting HNHC healthcare use. Meta-analysis was not possible due to heterogeneity. Most identified models estimated a patient’s risk to incur high healthcare expenditure during the subsequent year. However, case-finding strategies for HNHC care-management programmes are best informed by a model predicting HNHC persistence. Therefore, future studies should not only focus on validating and extending existing models, but also concentrate on clinical usefulness.

PENGARUH PENDIDIKAN KESEHATAN DENGAN MEDIA AUDIO VISUAL TERHADAP PENGETAHUAN KADER DALAM UPAYA PENEMUAN KASUS TB

Abstrak Indonesia menempati peringkat kedua dengan kasus (TB) tertinggi di dunia. Oleh sebab itu diperlukan strategi dalam penemuan kasus TB. Penelitian ini bertujuan meneliti pengaruh Pendidikan kesehatan dengan media Audio Visual terhadap pengetahuan kader dalam upaya penemuan kasus TB. Disain penelitian ini adalah pre eksperimen dengan desain One group pre-post test design. Sebanyak 10 orang kader terpilih sebagai responden dengan menggunakan teknik purposive sampling. Instrument penelitian menggunakan kuesioner berupa google form. Hasil penelitian menunjukkan Usia kader 70% berusia 41 tahun -50 tahun, mayoritas berpendidikan SMA (60%), sedangkan lama menjadi Kader TB mayoritas antara 1 tahun sampai 2 tahun (80%). Hasil analisis diketahui bahwa skor kader sebelum diberikan Pendidikan kesehatan dan setelah diberikan Pendidikan mengalami peningkatan yang signifikan. Nilai rerata skor hasil pre test adalah 69,30 dan setelah pelatihan meningkat menjadi 76,00., Hasil menunjukan ada perbedaan yang signifikan pengetahuan Kader sebelum dan sesudah dilakukan Pendidikan kesehatan (P value =0,007), dengan ini maka dapat disimpulkan ada perbedaan yang signifikan antara nilai ujian pre test dan nilai ujian pos test. Dengan demikian dapat disimpulkan bahwa pemberian Pendidikan Kesehatan dengan Audio Visual dapat digunakan dalam peningkatan pengetahuan kader dalam penemuan kasus TB. Abstract Indonesia ranks second with the highest cases (TB) in the world. Therefore, a strategy is needed in TB case finding. This study aims to examine the effect of health education with audio-visual media on cadres' knowledge to find TB cases. The design of this study was a pre-experimental design with a One group pre-post test design. A total of 10 cadres were selected as respondents using the purposive sampling technique. The research instrument used a questionnaire in the form of a google form. The results showed that 70% of cadres were aged 41 -50 years. The majority had high school education (60%), while most TB cadres had been between 1 year and two years (80%). The analysis results showed that the score of cadres before being given health education and after being given education experienced a significant increase. The mean score of the pre-test results was 69.30 and increased to 76.00. The results showed a considerable difference in Cadre knowledge before and after health education (P-value = 0.007). Thus scores can consider a significant difference between pre-test and post-test scores. It can be regarded as Audio Visual to increase cadres' knowledge in TB case finding.

Repairing boundaries along pathways to tuberculosis case detection: a qualitative synthesis of intervention designs

Background Tuberculosis case-finding interventions often involve several activities to enhance patient pathways, and it is unclear which activity defines the type of case-finding intervention. When conducting studies to identify the most effective case-finding intervention it is important to have a clear understanding of these interventions for meaningful comparisons. This review aimed to construct a systems-based logic model of all pathways to tuberculosis case detection through a synthesis of intervention designs. Methods We identified an existing systematic review on the effectiveness of interventions to increase tuberculosis case detection and updated the search from December 2016 to October 2020. We included randomized controlled trials, as these designs encourage detailed description of interventions. Taking each study in turn, intervention descriptions were read in detail. The texts were analysed qualitatively by constantly comparing emerging codes to construct patient journeys, visualized as logical chains. Actions taken as part of interventions were positioned along patient journeys to theorize the sequence of outcomes. Patient journeys formed the basis of the model, which was refined through discussion. Results Based on intervention descriptions from 17 randomized controlled trials, our model distinguishes two care-seeking pathways and four screening pathways. An open invitation to people with tuberculosis symptoms creates care-seeking pathways. On care-seeking pathways, systematic screening can be conducted at general health services, but not at specific TB care services. People invited to tuberculosis services regardless of symptoms follow tuberculosis screening pathways and may be identified with presumptive tuberculosis even if they do not seek care for tuberculosis symptoms. Tuberculosis screening pathways include screening offered to all people accessing care at general health services, screening at a mobile clinic or health facility with open invitation to a whole population or tuberculosis contacts, screening personally offered to a whole population or tuberculosis contacts at home, work or school, and screening offered to people receiving care for human immunodeficiency virus or other clinical risk-group care. Conclusion This systems-based logic model of tuberculosis case-finding pathways may support standardized terminology, consistency, transparency and improved communication among researchers, policy-makers, health workers and community members when implementing and evaluating interventions to improve tuberculosis case detection.

Enhancing and promoting data management and systematic monitoring for an improved HIV/AIDS programs in Addis Ababa, Ethiopia

Background Ethiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB). Methods AACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50–74%; red, < 50%). The command-post reviewed performance on weekly basis. A mentorship team provided a weekly site-level support at underperforming public and private health facilities. At facility level, quality of data on recording tools such as registers, and individual medical records were maintained through continued review, feedback mechanisms and regular consistency check of data. Percentage and 95% confidence interval were computed to compare the improvement in program performance over time. Results After 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23–46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03–77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01–33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38–65.6%] in September 2019. Conclusions Regular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.

The evidence for introducing case-finding for delirium and dementia in older medical inpatients in a New Zealand hospital

Objective The aim of this project was to make the case to the managers of a large urban teaching hospital in New Zealand for the introduction of systematic case-finding for pre-existing cognitive impairment/dementia in older hospital inpatients that screen positive for delirium. Method Two hundred consecutive acute admissions aged 75+ in four medical wards were assessed using the 4AT assessment tool for delirium and the Alzheimer Questionnaire (AQ) for pre-existing cognitive impairment/dementia. Length of stay and mortality at 1 year were also collected. Results Over a third of the sample screened positive for delirium and nearly two-thirds of these also screened positive for dementia. The median length of stay was 5 days for delirium without dementia and 7 days for delirium with dementia, compared to 3 days for those who screened negative for both. After adjustment for age, gender and ethnic group, people who screened positive for delirium (with or without dementia) had 50% longer length of stay ( p < 0.05) and at least double the risk of death ( p < 0.05). Conclusion Older hospital inpatients that screen positive for delirium and dementia using 4AT and AQ have longer lengths of stay and higher mortality. Identification may lead to more timely interventions that help to improve health outcomes and reduce hospital costs.

Validation of an algorithm to identify incident interstitial lung disease in patients with rheumatoid arthritis

Background/purpose Interstitial lung disease (ILD) is an important problem for patients with rheumatoid arthritis (RA). However, current approaches to ILD case finding in real-world data have been evaluated only in limited settings and identify only prevalent ILD and not new-onset disease. Our objective was to develop, refine, and validate a claims-based algorithm to identify both prevalent and incident ILD in RA patients compared to the gold standard of medical record review. Methods We used administrative claims data 2006–2015 from Medicare to derive a cohort of RA patients. We then identified suspected ILD using variations of ILD algorithms to classify both prevalent and incident ILD based on features of the data that included hospitalization vs. outpatient setting, physician specialty, pulmonary-related diagnosis codes, and exclusions for potentially mimicking pulmonary conditions. Positive predictive values (PPV) of several ILD algorithm variants for both prevalent and incident ILD were evaluated. Results We identified 234 linkable RA patients with sufficient data to evaluate for ILD. Overall, 108 (46.2%) of suspected cases were confirmed as ILD. Most cases (64%) were diagnosed in the outpatient setting. The best performing algorithm for prevalent ILD had a PPV of 77% (95% CI 67–84%) and for incident ILD was 96% (95% CI 85–100%). Conclusion Case finding in administrative data for both prevalent and incident interstitial lung disease in RA patients is feasible and has reasonable accuracy to support population-based research and real-world evidence generation.

HIV surveillance and research for migrant populations: a protocol integrating respondent-driven sampling, case finding, and medicolegal services for Venezuelans living in Colombia (Preprint)

BACKGROUND Epidemiologic research among migrant populations is limited by logistical, methodological, and ethical challenges, but necessary for informing public health and humanitarian programming. OBJECTIVE We describe a methodology to estimate HIV prevalence among Venezuelan migrants in Colombia. METHODS Respondent-driven sampling (RDS), a non-probability sampling method, was selected for attributes of reaching highly networked populations without sampling frames and analytic methods that permit estimation of population parameters. RDS was modified to permit electronic referral of peers via SMS and Whatsapp. Participants complete socio-behavioral surveys and rapid HIV and syphilis screening tests with confirmatory testing. HIV treatment is not available for migrants who have entered Colombia through irregular pathways; thus, medicolegal services integrated into post-test counseling provide staff lawyers and legal assistance to participants diagnosed with HIV or syphilis for sustained access to treatment through the national health system. Case finding is integrated into RDS to allow partner referral. The study is implemented by a local community-based organization providing HIV support services and related legal services for Venezuelans in Colombia. RESULTS Data collection launched in four cities in July and August 2021. As of November 2021, 3,105 of the target 6,100 participants were enrolled. CONCLUSIONS Tailored methods that combine community-led efforts with innovations in sampling and linkage to care can aid in advancing health research for migrant and displaced populations. Worldwide trends in displacement and migration underscore the value of improved methods for translation to humanitarian and public health programming.