Browsing by Author "Enarson, D. A."

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    Integration of TB and ART services fails to improve TB treatment outcomes : comparison of ART/TB primary healthcare services in Cape Town, South Africa
    (Health & Medical Publishing Group, 2014-03) Kaplan, R.; Caldwell, J.; Bekker, L-G.; Jennings, K.; Lombard, C.; Enarson, D. A.; Wood, R.; Beyers, Nulda
    Background. The combined tuberculosis (TB) and HIV epidemics in South Africa (SA) have created enormous operational challenges for a health service that has traditionally run vertical programmes for TB treatment and antiretroviral therapy (ART) in separate facilities. This is particularly problematic for TB/HIV co-infected patients who need to access both services. Objective. To determine whether integrated TB facilities had better TB treatment outcomes than single-service facilities in Cape Town, SA. Methods. TB treatment outcomes were determined for newly registered, adult TB patients (aged ≥18 years) at 13 integrated ART/TB primary healthcare (PHC) facilities and four single-service PHC facilities from 1 January 2009 to 30 June 2010. A χ2 test adjusted for a cluster sample design was used to compare outcomes by type of facility. Results. Of 13 542 newly registered patients, 10 030 received TB treatment in integrated facilities and 3 512 in single-service facilities. There was no difference in baseline characteristics between the two groups with HIV status determined for 9 351 (93.2%) and 3 227 (91.9%) patients, of whom 6 649 (66.3%) and 2 213 (63%) were HIV-positive in integrated facilities and single-service facilities, respectively. The median CD4+ count of HIV-positive patients was 152 cells/μl (interquartile range (IQR) 71 - 277) for integrated facilities and 148 cells/μl (IQR 67 - 260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p=0.56) or for the sub-set of HIV-positive TB patients (p=0.58) Conclusion. This study did not demonstrate improved TB treatment outcomes in integrated PHC facilities and showed that the provision of ART in the same facility as TB services was not associated with lower TB death and default rates.
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    Tuberculous lymphadenitis as a cause of persistent cervical lymphadenopathy in children from a tuberculosis-endemic area
    (2006) Marais, B. J.; Wright, C. A.; Schaaf, H. Simon; Gie, R. P.; Hesseling, A. C.; Enarson, D. A.; Beyers, Nulda
    Background: Cervical lymphadenitis is the most common form of extrapulmonary tuberculosis in children, although its relative contribution as a cause of persistent cervical adenopathy is not well-documented. The aim of this study was to determine the relative contribution of tuberculous lymphadenitis as a cause of persistent cervical adenopathy in a tuberculosis-endemic setting and to document its clinical presentation at the primary health care level. Methods: A prospective descriptive study was conducted from February 2003 through October 200 at 5 primary health care clinics in Cape Town, South Africa. The study included all children younger than 13 years presenting with persistent cervical adenopathy to the local primary health care clinic. Results: A total of 158 children were evaluated of whom 35 (22.2%) were diagnosed with tuberculous lymphadenitis. Bacteriologic confirmation was achieved in 27 of 35 (77.1%) children; all 35 responded to standard antituberculosis treatment. The majority of those without tuberculous lymphadenitis (105 of 123, 85.4%) had a visible superficial lesion in the area drained by the affected nodes. In children with persistent lymphadenopathy ≥2 x 2 cm, tuberculosis lymphadenitis was diagnosed in 31 of 33 (93.9%); specificity was 98.4%, sensitivity was 88.6% and the positive predictive value was 93.4%. Conclusion: Children commonly present with persistent cervical adenopathy to the primary health care clinic. The use of a simple clinical algorithm provided an accurate diagnosis of tuberculous lymphadenitis in the study setting. Fine needle aspirations provided a rapid and definitive diagnosis in the majority of children and will have added diagnostic value in settings where alternative diagnoses are more likely. Copyright © 2006 by Lippincott Williams & Wilkins.