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Search Results: 1 - 10 of 3322 matches for " Francis Drobniewski "
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Rates of Latent Tuberculosis in Health Care Staff in Russia
Francis Drobniewski ,Yanina Balabanova,Elena Zakamova,Vladyslav Nikolayevskyy,Ivan Fedorin
PLOS Medicine , 2007, DOI: 10.1371/journal.pmed.0040055
Abstract: Background Russia is one of 22 high burden tuberculosis (TB) countries. Identifying individuals, particularly health care workers (HCWs) with latent tuberculosis infection (LTBI), and determining the rate of infection, can assist TB control through chemoprophylaxis and improving institutional cross-infection strategies. The objective of the study was to estimate the prevalence and determine the relative risks and risk factors for infection, within a vertically organised TB service in a country with universal bacille Calmette-Guérin (BCG) vaccination. Methods and Findings We conducted a cross-sectional study to assess the prevalence of and risk factors for LTBI among unexposed students, minimally exposed medical students, primary care health providers, and TB hospital health providers in Samara, Russian Federation. We used a novel in vitro assay (for gamma-interferon [IFN-γ]) release to establish LTBI and a questionnaire to address risk factors. LTBI was seen in 40.8% (107/262) of staff and was significantly higher in doctors and nurses (39.1% [90/230]) than in students (8.7% [32/368]) (relative risk [RR] 4.5; 95% confidence interval [CI] 3.1–6.5) and in TB service versus primary health doctors and nurses: respectively 46.9% (45/96) versus 29.3% (34/116) (RR 1.6; 95% CI 1.1–2.3). There was a gradient of LTBI, proportional to exposure, in medical students, primary health care providers, and TB doctors: respectively, 10.1% (24/238), 25.5% (14/55), and 55% (22/40). LTBI was also high in TB laboratory workers: 11/18 (61.1%). Conclusions IFN-γ assays have a useful role in screening HCWs with a high risk of LTBI and who are BCG vaccinated. TB HCWs were at significantly higher risk of having LTBI. Larger cohort studies are needed to evaluate the individual risks of active TB development in positive individuals and the effectiveness of preventive therapy based on IFN-γ test results.
Analysis of how the health systems context shapes responses to the control of human immunodeficiency virus: case-studies from the Russian Federation
Atun,Rifat A.; McKee,Martin; Drobniewski,Francis; Coker,Richard;
Bulletin of the World Health Organization , 2005, DOI: 10.1590/S0042-96862005001000009
Abstract: objective: to develop a methodology and an instrument that allow the simultaneous rapid and systematic examination of the broad public health context, the health care systems, and the features of disease-specific programmes. methods: drawing on methodologies used for rapid situational assessments of vertical programmes for tackling communicable disease, we analysed programmes for the control human of immunodeficiency virus (hiv) and their health systems context in three regions in the russian federation. the analysis was conducted in three phases: first, analysis of published literature, documents and routine data from the regions; second, interviews with key informants, and third, further data collection and analysis. synthesis of findings through exploration of emergent themes, with iteration, resulted in the identification of the key systems issues that influenced programme delivery. findings: we observed a complex political economy within which efforts to control hiv sit, an intricate legal environment, and a high degree of decentralization of financing and operational responsibility. although each region displays some commonalities arising from the soviet traditions of public health control, there are considerable variations in the epidemiological trajectories, cultural responses, the political environment, financing, organization and service delivery, and the extent of multisectoral work in response to hiv epidemics. conclusion: within a centralized, post-soviet health system, centrally directed measures to enhance hiv control may have varying degrees of impact at the regional level. although the central tenets of effective vertical hiv programmes may be present, local imperatives substantially influence their interpretation, operationalization and effectiveness. systematic analysis of the context within which vertical programmes are embedded is necessary to enhance understanding of how the relevant policies are prioritized and translated to action.
Increasing reports of non-tuberculous mycobacteria in England, Wales and Northern Ireland, 1995-2006
Jonathan E Moore, Michelle E Kruijshaar, L Ormerod, Francis Drobniewski, Ibrahim Abubakar
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-612
Abstract: Hospital laboratories voluntarily report non-tuberculous mycobacterial infections to the Health Protection Agency Centre for Infections. Details reported include age and sex of the patient, species, specimen type and source laboratory. All reports were analysed.The rate of non-tuberculous mycobacteria reports rose from 0.9 per 100,000 population in 1995 to 2.9 per 100,000 in 2006 (1608 reports). Increases were mainly in pulmonary specimens and people aged 60+ years. The most commonly reported species was Mycobacterium avium-intracellulare (43%); M. malmoense and M. kansasii were also commonly reported. M. gordonae showed the biggest increase over the study period rising from one report in 1995 to 153 in 2006. Clinical information was rarely reported.The number and rate of reports increased considerably between 1995 and 2006, primarily in older age groups and pulmonary specimens. Increases in some species are likely to be artefacts but real changes in more pathogenic species, some of which will require clinical care, should not be excluded. Enhanced surveillance is needed to understand the true epidemiology of these infections and their impact on human health.The non-tuberculous mycobacteria (NTM), mycobacteria other than members of the Mycobacterium tuberculosis complex and M. leprae, have been documented since the 1950s as organisms capable of causing human disease [1], receiving greater clinical recognition as the incidence of tuberculosis fell [2]. Over 100 species of NTM have been identified but only around 15 are considered pathogenic in humans [3]. While NTM can cause pulmonary, lymph node, skin and disseminated disease in humans, many species are found ubiquitously in environmental reservoirs and in various domestic and wild animals and are therefore frequently isolated from clinical samples due to contamination. In general, NTM only cause disease in immunocompromised individuals, which is relative in small children, or actual, e.g. in those with HIV infectio
Performance of the Genotype? MTBDRPlus assay in the diagnosis of tuberculosis and drug resistance in Samara, Russian Federation
Vladyslav Nikolayevskyy, Yanina Balabanova, Tatyana Simak, Nadezhda Malomanova, Ivan Fedorin, Francis Drobniewski
BMC Clinical Pathology , 2009, DOI: 10.1186/1472-6890-9-2
Abstract: We performed an evaluation of the GenoType? MTBDRplus assay (HAIN Lifescience GmbH, Germany) on a total of 168 sputum specimens from individual patients at a public health laboratory in Central Russia, as a model of a middle income site in a region with high levels of drug resistance. Phenotypic drug resistance tests (DST) were performed on cultures derived from the same sputum specimens using the BACTEC 960 liquid media system.Interpretable GenoType? MTBDRplus results were obtained for 154(91.7%) specimens with readability rates significantly higher in sputum specimens graded 2+ and 3+ compared to 1+ (RR = 1.17 95%CI 1.04–1.32). The sensitivity and specificity of the assay for the detection of rifampicin (RIF) and isoniazid (INH) resistance and MDR was 96.2%, 97.4%, 97.1% and 90.7%, 83.3%, 88.9% respectively. Mutations in codon 531 of the rpoB gene and codon 315 of the katG gene dominated in RIF and INH resistant strains respectively. Disagreements between phenotypical and molecular tests results (12 samples) could be explained by the presence of rare mutations in strains circulating in Russia and simultaneous presence of resistant and sensitive bacilli in sputum specimens (heteroresistance).High sensitivity, short turnaround times and the potential for screening large numbers of specimens rapidly, make the GenoType? MTBDRplus assay suitable as a first-line screening assay for drug resistant TB.Emergence of multidrug resistance tuberculosis (MDRTB, i.e. resistance to at least rifampicin (RIF) and isoniazid (INH) in conjunction with increasing rates of HIV infection worldwide makes the rapid detection of TB drug resistance a key factor in patients' management and care. Rapid (within 1–2 days) diagnosis of MDRTB in clinical specimens allows the commencement of an appropriate TB treatment regimen earlier and helps to prevent transmission of drug resistant TB bacilli.The WHO estimates current MDRTB rates in new and previously treated cases globally at 2.9% and 15.3% re
The Role of the Interferon Gamma Release Assay in Assessing Recent Tuberculosis Transmission in a Hospital Incident
Louise Bradshaw,Elizabeth Davies,Michael Devine,Peter Flanagan,Paul Kelly,Kevin O'Connor,Francis Drobniewski,Vladislav Nikolayevskyy,Ibrahim Abubakar
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020770
Abstract: In 2007, an extensive contact screening investigation into onward transmission of tuberculosis was instigated at a hospital in Northern Ireland following diagnosis of pulmonary multi-drug resistant TB in a healthcare worker. Interferon gamma release assays (IGRAs) were used to test 333 patients and 98 staff. We investigated for evidence of onward transmission and recent infection based on analysis of clinical, demographic and IGRA data. We also described within-patient variability of IGRA results. Among patients and staff, increasing age of patients was the only factor associated with IGRA positivity. Greatest within-subject variability of IU/mL in serially-tested patients/staff was seen in those with a positive IGRA test and this did not correlate with increased exposure to the index case. IGRA positivity being largely explained by increasing age in patients and previous TB contact in staff lends weight to the conclusion that IGRA positivity reflected previous infection rather than recent transmission.
Analysis of undiagnosed tuberculosis-related deaths identified at post-mortem among HIV-infected patients in Russia: a descriptive study
Yanina Balabanova, Vladimir Tchernyshev, Igor Tsigankov, Svetlana Maximova, Natalya Mikheeva, Ljudmila Fedyukovitch, Sergey Kuznetsov, Ivan Fedorin, Francis Drobniewski
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-276
Abstract: We conducted a retrospective analysis of errors leading to death of HIV-positive patients in general health care hospitals in Togliatti, Russia, in 2008. All (n = 29) cases when tuberculosis was established at autopsy as a cause of death were included.Median length of hospital stay was 20 days; in 11 cases the death occurred within the first 24 hours of admission. All cases were known to be HIV-positive prior to admission, however HAART was not initiated for any case, and no relevant tests to assess severity of immunosupression were performed despite their availability. No appropriate diagnostic algorithms were applied to confirm tuberculosis. Major gaps were identified in the work of hospital and consulting physicians including insufficient records keeping. In almost all patients earlier regular HIV-relevant tests were not performed due to poor compliance of patients, many of whom abused alcohol and drugs.We conclude that introduction of prompt and accurate diagnostics tests, adequate treatment protocols and intensive training of physicians in management of AIDS and TB is vital. This should include reviewing standards of care for HIV-positive individuals with accompanying social problems.Tuberculosis (TB) remains a serious public health threat and economic burden in the Russian Federation with escalating rates of multi- and extensive drug resistance (MDR and XDR) against a background of poor infection control and active spread of resistance strains [1,2]. At the end of the 1990s, the HIV-epidemic emerged and is now spreading fast across the country with the number of registered cases being close to half a million by the end of 2009 [3]; the number of HIV-TB co-infection cases is increasing and according to national data TB is one of the most common causes of death of HIV-infected patients [4,5]. Due to the recent nature of the epidemic and the poor availability of antiretroviral drugs until recent years [6], Russian physicians have relatively limited experience of
Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia
Edford Sinkala, Sylvia Gray, Isaac Zulu, Victor Mudenda, Lameck Zimba, Sten H Vermund, Francis Drobniewski, Paul Kelly
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-44
Abstract: We screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples.Of 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71%) had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size), and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts <100 cells/μL.The clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count.The HIV epidemic in sub-Saharan Africa has contributed to an increased incidence of pulmonary tuberculosis (TB), but there is little information on changes in the frequency or clinical manifestations of abdominal TB. The annual risk of developing active TB, when co-infected with HIV, is 20 to 30 times the risk in seronegative individual [1,2]. In Africa, TB is the leading cause of mortality and morbidity in HIV infected patients, causing up to 41% of HIV-related deaths in Zaire [3]. In Zambia, the number of newly diagnosed cases of TB increased from 8,246 (124/100,000) in 1985 to 38,863 (409/100,000) in 1996 and 52,000 (512/100,000) in 2000 [2]. HIV infection is associated with a rise in the proportion of extrapulmonary TB, including pleural, pericardial, meningeal, lymphadenopathic, disseminated, and bone and joint infections. The proportion of extrapulmonary infection increases as the immunosuppression
Survival of Civilian and Prisoner Drug-Sensitive, Multi- and Extensive Drug- Resistant Tuberculosis Cohorts Prospectively Followed in Russia
Yanina Balabanova,Vladyslav Nikolayevskyy,Olga Ignatyeva,Irina Kontsevaya,Clare M. Rutterford,Anastasiya Shakhmistova,Nadezhda Malomanova,Yulia Chinkova,Svetlana Mironova,Ivan Fedorin,Francis A. Drobniewski
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020531
Abstract: A long-term observational study was conducted in Samara, Russia to assess the survival and risk factors for death of a cohort of non-multidrug resistant tuberculosis (non-MDRTB) and multidrug resistant tuberculosis (MDRTB) civilian and prison patients and a civilian extensive drug-resistant tuberculosis (XDRTB) cohort.
Health-systems efficiency in the Russian Federation: tuberculosis control
Floyd,Katherine; Hutubessy,Raymond; Samyshkin,Yevgeniy; Korobitsyn,Alexei; Fedorin,Ivan; Volchenkov,Gregory; Kazeonny,Boris; Coker,Richard; Drobniewski,Francis; Jakubowiak,Wieslaw; Shilova,Margarita; Atun,Rifat A;
Bulletin of the World Health Organization , 2006, DOI: 10.1590/S0042-96862006000100013
Abstract: objective: to conduct a comprehensive assessment of the case-mix of patients admitted to tuberculosis hospitals and the reasons for their admission in four russian regions: ivanovo, orel, samara and vladimir. we also sought to quantify the extent to which efficiency could be improved by reducing hospitalization rates and re-profiling hospital beds available in the tuberculosis-control system. methods: we used a standard questionnaire to determine how beds were being used and who was using the beds in tuberculosis facilities in four russian regions. data were collected to determine how 4306 tuberculosis beds were utilized as well as on the socioeconomic and demographic indicators, clinical parameters and reasons for hospitalization for 3352 patients. findings: of the 3352 patients surveyed about 70% were male; the average age was 40; and rates of unemployment, disability and alcohol misuse were high. about one-third of beds were occupied by smear-positive or culture-positive tuberculosis patients; 20% were occupied by tuberculosis patients who were smear-negative and/or culture-negative; 20% were occupied by patients who no longer had tuberculosis; and 20% were unoccupied. if clinical and public health admission criteria were applied then < 50% of admissions would be justified and < 50% of the current number of beds would be required. up to 85% of admissions and beds were deemed to be necessary when social problems and poor access to outpatient care were considered along with clinical and public health admission criteria. conclusion: much of the russian federation's large tuberculosis hospital infrastructure is unnecessary when clinical and public health criteria are used, but the large hospital infrastructure within the tuberculosis-control system has an important social support function. improving the efficiency of the system will require the reform of health-system norms and regulations as they relate to resource allocation and clinical care and implementation of
Control of (Multi)Drug Resistance and Tuberculosis Incidence over 23 Years in the Context of a Well-Supported Tuberculosis Programme in Rural Malawi
Sebastian M. Mboma, Rein M. G. J. Houben, Judith R. Glynn, Lifted Sichali, Francis Drobniewski, James Mpunga, Paul E. M. Fine, Neil French, Amelia C. Crampin
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058192
Abstract: Background The rise in tuberculosis (TB) incidence following generalized HIV epidemics can overwhelm TB control programmes in resource-limited settings, sometimes accompanied by rising rates of drug resistance. This has led to claims that DOTS-based TB control has failed in such settings. However, few studies have described the effect of a sustained and well-supported DOTS programme on TB incidence and drug resistance over a long period. We present long-term trends in incidence and drug resistance in rural Malawi. Methods Karonga District in northern Malawi has an adult HIV prevalence of ~10%. A research group, the Karonga Prevention Study, collaborates with the National Tuberculosis Programme to support core TB control activities. Bacteriological, demographic and clinical (including HIV status) information from all patients starting TB treatment in the District have been recorded since 1988. During that period isolates from each culture-positive TB patient were exported for drug sensitivity testing. Antiretroviral therapy (ART) has been widely available since 2005. Results Incidence of new smear-positive adult TB peaked at 124/100,000/year in the mid-90s, but has since fallen to 87/100,000/year. Drug sensitivity information was available for 95% (3132/3307) of all culture-positive cases. Initial resistance to isoniazid was around 6% with no evidence of an increase. Fewer than 1% of episodes involved a multi-drug resistant strain. Discussion In this setting with a generalised HIV epidemic and medium TB burden, a well-supported DOTS programme enhanced by routine culture and drug sensitivity testing may well have reduced TB incidence and maintained drug resistance at low levels.
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