Prison
settings have been often identified as important but neglected reservoirs for
TB. This study was designed to determine the prevalence of undiagnosed
pulmonary TB and assess the potential risk factors for such TB cases in prisons
of the Tigray region.
METHOD:
A
cross-sectional study was conducted between August 2013 and February 2014 in
nine prisons. A standardized symptom-based questionnaire was initially used to
identify presumptive TB cases. From each, three consecutive sputum samples were
collected for acid-fast bacilli (AFB) microscopy and culture. Blood samples
were collected from consented participants for HIV testing.
RESULT:
Out of 809
presumptive TB cases with culture result, 4.0% (95% CI: 2.65-5.35) were
confirmed to have undiagnosed TB. The overall estimated point prevalence of
undiagnosed TB was found to be 505/100,000 prisoners (95% CI: 360-640).
Together with the 27 patients who were already on treatment, the overall
estimated point prevalence of TB would be 793/100,000 prisoners (95% CI:
610-970), about four times higher than in the general population. The ratio of
active to passive case detection was 1.18:1. The prevalence of HIV was 4.4%
(36/809) among presumptive TB cases and 6.3% (2/32) among undiagnosed TB cases.
In a multivariate logistic regression analysis, chewing Khat (adjusted OR =
2.81; 95% CI: 1.02-7.75) and having had a close contact with a TB patient
(adjusted OR = 2.18; 95% CI: 1.05-4.51) were found to be predictors of
undiagnosed TB among presumptive TB cases.
CONCLUSIONS:
This
study revealed that at least half of symptomatic pulmonary TB cases in Northern
Ethiopian prisons remain undiagnosed and hence untreated. The prevalence of
undiagnosed TB in the study prisons was more than two folds higher than in the
general population of Tigray. This may indicate the need for more investment
and commitment to improving TB case detection in the study prisons.
Late diagnosis and presentation to human
immune deficiency virus (HIV)/acquired immune deficiency syndrome care reduce
the benefits of antiretroviral therapy and increase the risk of HIV
transmission.
Objectives
This study was conducted to identify
determinants of late presentation to HIV care among people living with HIV in
Southern Tigray, Northern Ethiopia.
Methods
An institution based un-matched
case–control (1:2 ratios) supported with qualitative data was conducted in
Southern Tigray Zone from March 1 to April 30, 2014. Individuals with HIV
enrolled from six randomly selected health facilities were included in the study.
Cases were people living with HIV who had cluster of differentiation four
count <350 cells/μl or World Health Organization stages 3 or 4. A total
of 442 study participants were included by systematic sampling techniques.
Bivariable and multivariable binary logistic regression model was used to
identify associated factors. Odds ratio with 95 % CI was computed to
assess the strength of the associations.
Result
Age categories, 25–29 years and 35–39 years,
having two and more lifetime sexual partners, poor social support, second (next to lowest) wealth quintile, fear of stigma, fear of losing
job, and reported severe illness were identified to be the risk factors for late
presentation.
Conclusion
Low socio-economic status and social
support, fear of stigma were potential risk factors for late presentation.
Efforts towards promoting early care seeking should target on these factors in
the study area and other similar settings.
Table 3
FGD results extracted from HIV positive individuals works on mothers supporting groups concerning barriers to early HIV/AIDS care, Southern Tigray Zone, April 2014
Barriers to HIV/AIDS care
HIV/AIDS positive individuals working on Mother Supporting Group
Fear of stigma
“… I was worried that people will talk about me if they hear I tested positive”… Male-32 “When I became aware of my HIV status my challenge was fear of health professionals and seeing other individuals I know while attending the ART clinic”, Female-27.
Fear of losing income source/former job
“People seem supportive towards HIV positives at first, but the pain is that they gradually change their feeling and treat you as ‘too weak’ to accomplish your duty …HIV positives will be shifted to lower status/position”, Male-55
“Although they are HIV positive, numerous commercial sex workers in the town continue their commercial sex work”, Female-27
Use of non-medical treatment
“…then she ate a dried Wild boar’s meat and Wild boar’s bile”, Female-30
“…he told me a very bitter plant called ‘Oure’ or ‘Eret’ is medicine for HIV and he had been drinking it until he ended up dying”, Female-30
“I went to a local traditional healer called ‘TonqualIi’ or magician and spent around 3000 Ethiopian Birr then he told to my wife wash my body using sheep’s blood and dung added together ….”, Male-38
“There was one HIV-positive neighbor with symptoms of diarrhea, she bought drugs from the pharmacy, was relieved of her symptoms for some time and then went to other pharmacy a few days later….”, Female-30
“My husband and were severely diseased and confined to bed for around 6 months. He had been telling that his illness was due to other diseases like malaria, and he has been getting medicines from drug stores”, Female-34
Low families driving force for initiation care
“We should let peoples think for the next generation…If my children are healthy…..”, Male -32 … “My child is negative”, Female-27, “My wife and children are negative”, Males-32, 55
Inadequacy of social support (spouse, friends and religious leaders)
“… I show him my ART drugs that I am taking and he became persuaded to take his treatment too”, Female-55
“I become angry and decided not to take any treatment for 1 year. Later on my friends were taking HIV treatment and they encouraged me to take treatment.” Male-28
“Males say that we are healthy even though we have the HIV and nothing bad is going on us, but, females become ill and suffer from headache and they come to ART clinics saying I tested positive for HIV …”, Female-27
“….later on my wife went to the health center and tested positive after that she encouraged me to be tested …”, Male-38
“…..I then persuaded my husband to be tested for HIV and avoided taking other drugs from outside the treatment center’’, Female-34
“My brother shouts at me, you should be tested and know the cause for your illness today; I will help every expense that follows …..”, Female-35
“…she was severely ill and her family said that they didn’t want to take care of the dead”, Female-27
Inadequate knowledge
“The HIV testing sites that are conducted in the shade in town are always crowded with people being tested, especially males. But they don’t come to care once they have tested positive [F-55] and they can only be accessed after they become diseased, arriving on a stretcher or by ambulance, or when found during house-to-house tracing by volunteer HIV support groups. …”, Female-34
