Background: Discontinuation remains a legitimate threat to the long-term success of antiretroviral therapy (ART) scale-up in Zimbabwe. Furthermore, the characteristics associated with ART discontinuation and trends ar...Background: Discontinuation remains a legitimate threat to the long-term success of antiretroviral therapy (ART) scale-up in Zimbabwe. Furthermore, the characteristics associated with ART discontinuation and trends are poorly understood in developing countries like Zimbabwe. We analysed the HIV/AIDS data to describe the characteristics associated with ART discontinuation and the trends from 2015 to 2019. Methods: We conducted an analytical cross- sectional study using secondary data from Electronic Patient Management System (ePMS) in Kadoma City. We interviewed eighteen health care workers to find the reasons for ART discontinuation. Data were analysed using Microsoft Office Excel 2016 and Epi info 7 version 7.2.2.6. Microsoft office excel was used to generate linear graphs to demonstrate the trends in ART discontinuation in Kadoma City in 2015-2019. Epi info 7 was used to generate frequencies, means, prevalence odds ratios p-values, and 95% confidence intervals (CI) and significance testing. Backward stepwise logistic regression analysis was done to determine the independent factors associated with discontinuation. Results: A total number of 2833 patients were enrolled on ART from 2015 to 2019. One hundred and seventy-three 173/2833 (6.1%) discontinued ART, 415/2833 (14.7%) transferred out, 69/2833 (2.4%) died and 2176/2833 (76.8%) were retained on ART. Out of those who discontinued ART, sixty-five percent (112/173) were females. Approximately two-thirds had immunological failure 110/173 (64%). The trend in ART discontinuation decreased over the years but was not statistically significant (R<sup>2</sup> = 0.57, p > 0.05). ART discontinuation was independently associated with being Conclusion: We concluded that the characteristics associated with ART discontinuation were having never attended school, being less than forty years of age and having immunological failure. The reasons why patients discontinue ART were health state not improving, participating in artisanal mining activities, change in marital status, medical side effects of ART, living far from health facilities, and relocating to neighbouring countries. We recommended continuous provision of health education, enhanced adherence counselling sessions to those with unsuppressed viral loads and investigating the cause of virologic failure.展开更多
Background: Zimbabwe was 17th among 22 tuberculosis (TB) high burdened countries. In Zimbabwe, the TB case notification system tracks data on case detection and treatment. Mhondoro-Ngezi district was reporting less th...Background: Zimbabwe was 17th among 22 tuberculosis (TB) high burdened countries. In Zimbabwe, the TB case notification system tracks data on case detection and treatment. Mhondoro-Ngezi district was reporting less than half provincial case average of 251 cases per 100,000 population per year. Data were always two weeks late. We evaluated the surveillance system and determined reasons for low notification. Methods: A descriptive cross sectional study was conducted using the updated CDC guidelines. Structured questionnaires, notification registers and forms were used to collect data. Epi Info 7 was used to calculate means and frequencies. Results: All 17 facilities providing TB services were selected. Only two of these were diagnostic centres. Of the 41 health workers, 32 (78%) were nurses. All facilities were notifying and 38 (93%) of health workers had notified cases. Notification forms were available at all facilities and were transported to the district office by government vehicles once completed. Ten minutes on average were needed to complete a form and this was easy for 89% health workers. Data were being analysed at facilities by 83% of health workers and 71% took action after analysis. Feedback from district level was being received by 85% of health workers. The reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. Conclusions: The TB case notification system was acceptable, simple, representative and useful. Reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. As a result of this evaluation, a third diagnostic centre is being set up.展开更多
文摘Background: Discontinuation remains a legitimate threat to the long-term success of antiretroviral therapy (ART) scale-up in Zimbabwe. Furthermore, the characteristics associated with ART discontinuation and trends are poorly understood in developing countries like Zimbabwe. We analysed the HIV/AIDS data to describe the characteristics associated with ART discontinuation and the trends from 2015 to 2019. Methods: We conducted an analytical cross- sectional study using secondary data from Electronic Patient Management System (ePMS) in Kadoma City. We interviewed eighteen health care workers to find the reasons for ART discontinuation. Data were analysed using Microsoft Office Excel 2016 and Epi info 7 version 7.2.2.6. Microsoft office excel was used to generate linear graphs to demonstrate the trends in ART discontinuation in Kadoma City in 2015-2019. Epi info 7 was used to generate frequencies, means, prevalence odds ratios p-values, and 95% confidence intervals (CI) and significance testing. Backward stepwise logistic regression analysis was done to determine the independent factors associated with discontinuation. Results: A total number of 2833 patients were enrolled on ART from 2015 to 2019. One hundred and seventy-three 173/2833 (6.1%) discontinued ART, 415/2833 (14.7%) transferred out, 69/2833 (2.4%) died and 2176/2833 (76.8%) were retained on ART. Out of those who discontinued ART, sixty-five percent (112/173) were females. Approximately two-thirds had immunological failure 110/173 (64%). The trend in ART discontinuation decreased over the years but was not statistically significant (R<sup>2</sup> = 0.57, p > 0.05). ART discontinuation was independently associated with being Conclusion: We concluded that the characteristics associated with ART discontinuation were having never attended school, being less than forty years of age and having immunological failure. The reasons why patients discontinue ART were health state not improving, participating in artisanal mining activities, change in marital status, medical side effects of ART, living far from health facilities, and relocating to neighbouring countries. We recommended continuous provision of health education, enhanced adherence counselling sessions to those with unsuppressed viral loads and investigating the cause of virologic failure.
文摘Background: Zimbabwe was 17th among 22 tuberculosis (TB) high burdened countries. In Zimbabwe, the TB case notification system tracks data on case detection and treatment. Mhondoro-Ngezi district was reporting less than half provincial case average of 251 cases per 100,000 population per year. Data were always two weeks late. We evaluated the surveillance system and determined reasons for low notification. Methods: A descriptive cross sectional study was conducted using the updated CDC guidelines. Structured questionnaires, notification registers and forms were used to collect data. Epi Info 7 was used to calculate means and frequencies. Results: All 17 facilities providing TB services were selected. Only two of these were diagnostic centres. Of the 41 health workers, 32 (78%) were nurses. All facilities were notifying and 38 (93%) of health workers had notified cases. Notification forms were available at all facilities and were transported to the district office by government vehicles once completed. Ten minutes on average were needed to complete a form and this was easy for 89% health workers. Data were being analysed at facilities by 83% of health workers and 71% took action after analysis. Feedback from district level was being received by 85% of health workers. The reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. Conclusions: The TB case notification system was acceptable, simple, representative and useful. Reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. As a result of this evaluation, a third diagnostic centre is being set up.
