Browsing by Author "Gengiah, Santhanalakshmi."

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Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.
(Implementation Science., 2015) Naidoo, Kogieleum.; Gengiah, Santhanalakshmi.; Yende-Zuma, Fortunate Nonhlanhla.; Padayatchi, Nesri.; Barker, Pierre.; Nunn, Andrew.; Subrayen, Priashni.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
The association of organizational contextual factors and HIV-Tuberculosis service integration following exposure to quality improvement interventions in primary healthcare clinics in rural KwaZulu-Natal.
(2021) Gengiah, Santhanalakshmi.; Loveday, Marian Patricia.; Taylor, Myra.
A key strategy to reduce Tuberculosis (TB)-related mortality among people living with HIV is integrating HIV and TB diagnostic and treatment services. In South Africa, integrated HIV-TB service provision is standard of care, however, there is evidence that patients accessing primary healthcare clinics (PHC) are missed for HIV and TB testing and screening, diagnosis, linkage to treatment, and preventive services. Gaps in the HIV-TB care cascade are indicative of weaknesses in healthcare systems at the frontline. Quality Improvement (QI) collaboratives are a widely adopted approach to facilitating improvement among multiple clinics and scaling up best practices to improve on a given health topic. Little is known of the effectiveness of QI collaboratives and less is known of the role of organizational contextual factors (OCFs) in influencing the success of QI collaboratives to improve integrated HIV-TB services. Scaling up TB/HIV Integration (SUTHI) was a cluster-randomised trial designed to test the effectiveness of a QI intervention to enhance integrated HIV-TB services on mortality in HIV, TB, and HIV-TB patients. The study was from 01 December 2016-31 December 2018. Sixteen nurse supervisors (clusters) overseeing 40 PHC clinics were randomized (1:1) to receive either a structured QI intervention (QI group), which comprised, clinical training, three QI workshops timed at 6-month intervals, and in-person mentorship visits; or standard of care (SOC group) supervision and support for HIV-TB service delivery. This PhD project was a nested sub-study embedded in the SUTHI trial which aimed to describe and assess the influence of OCFs on the QI intervention to improve process indicators of HIV-TB services. A description of the QI intervention, including change ideas generated and lessons learned from practical application of the intervention in 20 QI clinics are presented in Paper I. Baseline performance of indicators was highlighted as important in influencing the size of improvements. OCFs that undermined the QI process were poor data quality, data capturing backlogs, lack of data analytic skills among clinic staff, poor transfer of training knowledge to peers, low clinic staff motivation to consistently track performance and limited involvement of the clinic management team in QI activities due to heavy workloads. A comparison between the QI and SOC group clinics showed that the QI intervention was only effective in improving two of five HIV-TB indicators, HIV testing services (HTS) andIsoniazid Preventive Therapy (IPT) initiation rates in new antiretroviral therapy patients. HTS was 19% higher (94.5% versus (vs) 79.6%; Relative Risk (RR)=1.19; 95% CI:1.02% - 1.38%; p=0.029) and IPT initiation was 66% higher (61.2% vs 36.8%; RR=1.66; 95% CI:1.02% -2.72%; p=0.044), in the QI group compared to the SOC group. Small clusters showed larger improvements in IPT initiation rates compared to big clusters, likely due to better coordination of efforts (Paper II). Several OCFs were quantitatively assessed and inserted into a linear mixed model to determine which factors likely influenced the improvement observed in the IPT initiation rates (Paper III). The practice of monitoring data for improvement was significantly associated with higher IPT initiation rates (Beta coefficient (β)=0.004; p=0.004). The main recommendations made from the PhD project are to encourage the practice of monitoring data for improvement among clinic teams; provision of widespread QI training for all levels of staff, different staff categories and leadership; to ensure good quality of routine data, and provision of regular performance feedback from upper management to the clinics.
Cost-effectiveness of initiating antiretroviral therapy at different points in TB treatment in HIV-TB co-infected ambulatory patients in South Africa.
(Wolters Kluwer., 2015) Naidoo, Kogieleum.; Grobler, Anna Christina.; Deghaye, Nicola.; Reddy, Tarylee.; Gengiah, Santhanalakshmi.; Gray, Andrew Lofts.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
Early experiences with Isoniazid Preventive Therapy roll-out in an ART programme : a pharmacist's perspective.
(2016) Maharaj, Bhavna.; Yende-Zuma, Fortunate Nonhlanhla.; Naidoo, Anushka.; Gengiah, Santhanalakshmi.; Naidoo, Kogieleum.
Tuberculosis (TB) remains the leading cause of mortality amongst people infected with Human Immunodeficiency Virus (HIV). Additionally, TB recurrence after successful treatment completion occurs more frequently amongst HIV positive people. Isoniazid provided as part of isoniazid preventive therapy (IPT) has been the gold standard of TB preventive therapy provision for the last few decades. IPT has been recommended by the World Health Organisation (WHO) and implemented by national health programmes in countries across the world. Despite global efforts and campaigns to promote IPT, uptake still remains a challenge and, progress in the operational scale- up of IPT is slow. Both international and in-country guidelines have advanced to recommending the use of IPT in HIV infected patients who have previously been treated for TB because these patients remain at risk for recurrent TB especially in TB endemic settings. However, there still remains a paucity in data on the successful programmatic use of IPT secondary to previous cured TB among HIV infected patients and is the focus of the current analysis from a pharmacists’ perspective. Methods: A retrospective secondary analysis was conducted from October 2009 to October 2013, amongst HIV infected patients, previously treated for TB, accessing HIV care at the urban CAPRISA clinical research clinic in Durban, South Africa. The aim of the study was to evaluate the implementation of Isoniazid Preventive Therapy (IPT) within the parent study titled “TB recurrence upon treatment with HAART” (TRuTH). Data was collected on IPT uptake, course completion, drug toxicity, treatment interruption, and the occurrence of incident TB either during treatment or post IPT completion. The multidisciplinary team approach in providing IPT to at risk HIV infected patients, including the specific role of the pharmacist, was also assessed. Results: There were 402 patients enrolled in the parent study. Of these 344 (85.6%) were eligible to receive IPT and of whom 212 (61.6%) initiated IPT. Among those that commenced IPT, 184 (86.8%) completed the six-month course, 24 (11.3%) permanently discontinued IPT and of these, 3.8% discontinued due to side effects. More women (n=130; 61.3%) were initiated on IPT (p=0.001) than men. Overall median adherence to IPT was 97.6% (IQR: 94.2 - 99.4). There were 22 cases of incident TB in this cohort: 13 occurred prior to IPT and nine after IPT (incidence rate ratio 0.67; 95% CI 0.29- 1.58; p=0.362). CONCLUSIONS: Overall, we demonstrated a successful IPT roll-out in a high TB endemic setting with good uptake of IPT, minimal course interruptions or side effects reported. IPT is a safe and tolerable TB prevention intervention within ART programmes and importantly amongst patients on ART with previous TB treatment experience. The pharmacist played an important role in continuum of care in IPT provision within an ART programme. This role included ensuring stable supply chain management, supporting clinic staff in monitoring safe IPT use and provided data on IPT course completion rates
The immune reconstitution inflammatory syndrome after antiretroviral therapy initiation in patients with tuberculosis: findings from the SAPiT trial.
(American College of Physicians., 2012) Naidoo, Kogieleum.; Yende Zuma, Nonhlanhla.; Padayatchi, Nesri.; Naidoo, Kasavan.; Jithoo, Niraksha.; Nair, Gonasagrie.; Bamber, Sheila.; Gengiah, Santhanalakshmi.; El-Sadr, Wafaa M.; Friedland, Gerald H.; Abdool Karim, Salim Safurdeen.
Background: Concerns about the immune reconstitution inflammatory syndrome (IRIS) remain a barrier to antiretroviral therapy (ART) initiation during antituberculosis treatment in co-infected patients. Objective: To assess IRIS incidence, severity, and outcomes relative to the timing of ART initiation in patients with HIV-related tuberculosis. Design: Randomized, open-label clinical trial. (ClinicalTrials.gov registration number: NCT00398996) Setting: An outpatient clinic in Durban, South Africa. Patients: 642 patients co-infected with HIV and tuberculosis. Measurements: In a secondary analysis of the SAPiT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) trial, IRIS was assessed in patients randomly assigned to initiate ART within 4 weeks of tuberculosis treatment initiation (early integrated treatment group), within 4 weeks of completion of the intensive phase of tuberculosis treatment (late integrated treatment group), or within 4 weeks after tuberculosis therapy completion (sequential treatment group). The syndrome was defined as new-onset or worsening symptoms, signs, or radiographic manifestations temporally related to treatment initiation, accompanied by a treatment response. Severity of IRIS, hospitalization, and time to resolution were monitored. Results: Incidence of IRIS was 19.5 (n = 43), 7.5 (n = 18), and 8.1 (n = 19) per 100 person-years in the early integrated, late integrated, and sequential treatment groups, respectively. Among patients with a baseline CD4+ count less than 0.050 × 10.9 cells/L, IRIS incidence was 45.5, 9.7, and 19.7 per 100 person-years in the early integrated, late integrated, and sequential treatment groups, respectively. Incidence of IRIS was higher in the early integrated treatment group than in the late integrated (incidence rate ratio, 2.6 [95% CI, 1.5 to 4.8]; P < 0.001) or sequential (incidence rate ratio, 2.4 [CI, 1.4 to 4.4]; P < 0.001) treatment groups. More severe IRIS cases occurred in the early integrated treatment group than in the other 2 groups (35% vs. 19%; P = 0.179), and patients in the early integrated treatment group had significantly higher hospitalization rates (42% vs. 14%; P = 0.007) and longer time to resolution (70.5 vs. 29.0 days; P = 0.001) than patients in the other 2 groups. Limitations: It was not possible to assess IRIS in more patients in the sequential treatment group (n = 74) than in the late integrated (n = 50) and early integrated (n = 32) treatment groups because of loss to follow-up, withdrawal, or death within 6 months of scheduled ART initiation. This study did not assess IRIS risk in nonambulatory patients or in those with extrapulmonary and smear-negative tuberculosis. Conclusion: Initiation of ART in early stages of tuberculosis treatment resulted in significantly higher IRIS rates, longer time to resolution, and more severe cases of IRIS requiring hospitalization. These findings are particularly relevant to patients initiating ART with a CD4+ count less than 0.050 × 10.9 cells/L, given the increased survival benefit of early ART initiation in this group.
Implementing isoniazid preventive therapy in a tuberculosis treatment-experienced cohort on ART.
(International Union against Tuberculosis and Lung Disease., 2017) Maharaj, Bhavna.; Gengiah, Tanuja Narayansamy.; Yende-Zuma, Fortunate Nonhlanhla.; Gengiah, Santhanalakshmi.; Naidoo, Anushka.; Naidoo, Kogieleum.
Abstract available in pdf.
Individualised motivational counselling to enhance adherence to antiretroviral therapy is not superior to didactic counselling in South African patients: Findings of the CAPRISA 058 randomised controlled trial.
(Springer., 2015) van Loggerenberg, Francois.; Grant, Alison D.; Naidoo, Kogieleum.; Murrman, Marita.; Gengiah, Santhanalakshmi.; Gengiah, Tanuja Narayansamy.; Fielding, Katherine L.; Abdool Karim, Salim Safurdeen.
Abstract available in pdf.
Integration of antiretroviral therapy with tuberculosis treatment.
(Massachusetts Medical Society., 2011) Abdool Karim, Salim Safurdeen.; Naidoo, Kogieleum.; Grobler, Anna Christina.; Padayatchi, Nesri.; Baxter, Cheryl.; Gray, Andrew Lofts.; Gengiah, Tanuja Narayansamy.; Gengiah, Santhanalakshmi.; Naidoo, Anushka.; Jithoo, Niraksha.; Nair, Gonasagrie.; El-Sadr, Wafaa M.; Friedland, Gerald H.; Abdool Karim, Quarraisha.
Background. We previously reported that integrating antiretroviral therapy (ART) with tuberculosis treatment reduces mortality. However, the timing for the initiation of ART during tuberculosis treatment remains unresolved. Methods. We conducted a three-group, open-label, randomized, controlled trial in South Africa involving 642 ambulatory patients, all with tuberculosis (confirmed by a positive sputum smear for acid-fast bacilli), human immunodeficiency virus infection, and a CD4+ T-cell count of less than 500 per cubic millimeter. Findings in the earlier- ART group (ART initiated within 4 weeks after the start of tuberculosis treatment, 214 patients) and later-ART group (ART initiated during the first 4 weeks of the continuation phase of tuberculosis treatment, 215 patients) are presented here. Results. At baseline, the median CD4+ T-cell count was 150 per cubic millimeter, and the median viral load was 161,000 copies per milliliter, with no significant differences between the two groups. The incidence rate of the acquired immunodeficiency syndrome (AIDS) or death was 6.9 cases per 100 person-years in the earlier-ART group (18 cases) as compared with 7.8 per 100 person-years in the later-ART group (19 cases) (incidence-rate ratio, 0.89; 95% confidence interval [CI], 0.44 to 1.79; P = 0.73). However, among patients with CD4+ T-cell counts of less than 50 per cubic millimeter, the incidence rates of AIDS or death were 8.5 and 26.3 cases per 100 person-years, respectively (incidence-rate ratio, 0.32; 95% CI, 0.07 to 1.13; P = 0.06). The incidence rates of the immune reconstitution inflammatory syndrome (IRIS) were 20.1 and 7.7 cases per 100 person-years, respectively (incidence-rate ratio, 2.62; 95% CI, 1.48 to 4.82; P<0.001). Adverse events requiring a switching of antiretroviral drugs occurred in 10 patients in the earlier-ART group and 1 patient in the later-ART group (P = 0.006). Conclusions. Early initiation of ART in patients with CD4+ T-cell counts of less than 50 per cubic millimeter increased AIDS-free survival. Deferral of the initiation of ART to the first 4 weeks of the continuation phase of tuberculosis therapy in those with higher CD4+ T-cell counts reduced the risks of IRIS and other adverse events related to ART without increasing the risk of AIDS or death.
An investigation into the psychosocial factors associated with willingness to test for HIV among a sample of first year psychology students at a South African tertiary institution.
(2006) Gengiah, Santhanalakshmi.; Solomon, Vernon Philip.
HIV/AIDS has exacted a devastating death toll on sub-Saharan Africa. Of the African countries South Africa has been the hardest hit by the epidemic. Young people between the ages 15-24 have been identified as the group most at risk for contracting HIV. The introduction of highly active antiretroviral therapy (HAART) has been shown to decrease opportunistic infections and increase lifespan and quality of life of HIV infected people. VCT is an entry point to accessing life saving treatment as well as psycho-emotional and social support. A concern is that not all people who are at risk for VCT get tested. It is important to examine which psychosocial factors affect the uptake of VCT. A questionnaire that measures willingness to test for HlV and various other psychosocial and socio-demographic factors affecting VCT uptake, was administered to a group of first year psychology students, (N= 181). Chi Square (X2 ) analysis determined that knowledge of HIV transmission, knowledge of VCT, fear of testing, perceived social support and perceived social stigma were significantly associated with willingness to test for HIV (p
A qualitative study of patient motivation to adhere to combination antiretroviral therapy in South Africa.
(Mary Ann Liebert., 2015) van Loggerenberg, Francois.; Gray, Debra.; Gengiah, Santhanalakshmi.; Kunene, Pinky.; Gengiah, Tanuja Narayansamy.; Naidoo, Kogieleum.; Grant, Alison D.
Abstract available in pdf.
Recurrent tuberculosis among HIV-coinfected patients: a case series from KwaZulu-Natal.
(Dove Medical Press., 2018) Naidoo, Kogieleum.; Dookie, Navisha.; Naidoo, Kasavan.; Yende-Zuma, Fortunate Nonhlanhla.; Chimukangara, Benjamin.; Bhushan, Ambika.; Govender, Dhineshree.; Gengiah, Santhanalakshmi.; Padayatchi, Nesri.
Abstract available in pdf.
Role of education in HIV clinical outcomes in a tuberculosis endemic setting.
(Sage., 2013) Cohen, Gabriel M.; Werner, Lise.; Gengiah, Santhanalakshmi.; Naidoo, Kogieleum.
This study evaluated how educational attainment impacts clinical outcomes of HIV-positive patients in Durban, South Africa. The authors conducted a prospective study of 466 adult HIV-positive patients initiating antiretroviral therapy (ART) at an urban TB-HIV clinic from October 2004 to June 2007. The level of educational attainment (highest grade completed) was assessed at ART initiation. The authors measured tuberculosis treatment outcomes as well as death, lost to follow-up, viral suppression (HIV RNA <400 copies/mL), and immunologic response (CD4 ≥ 200 cells/mm³) at 6, 12, and 24 months after ART initiation. After 24 months of ART initiation, there were 43 deaths; viral suppression and immunologic response were observed in 88% and 83% of the remaining patients, respectively. The authors found no association between level of educational attainment and mortality (P = .12), loss to follow-up (P = .85), virologic response (P = .51), or immunologic response (P = .63). Similar findings were observed at 6 and 12 months post-ART initiation.
Role of oral candidiasis in TB and HIV co-infection: AIDS Clinical Trial Group Protocol A5253.
(The Union., 2014) Shiboski, Caroline H.; Chen, Huichao.; Ghannoum, Mahmoud A.; Komarow, Lauren.; Evans, Scott.; Mukherjee, Pranab K.; Isham, Nancy.; Katzenstein, David.; Asmelash, Aida.; Omozoarhe, A. E.; Gengiah, Santhanalakshmi.; Allen, Reena.; Tripathy, Srikanth.; Swindells, Susan.
Abstract available in pdf.