A5084644045- Tuberculosis Research and Epidemiology
- Pneumocystis jirovecii pneumonia detection and treatment
- Mycobacterium research and diagnosis
- Diagnosis and treatment of tuberculosis
- Infectious Diseases and Tuberculosis
- HIV/AIDS Research and Interventions
- HIV/AIDS Impact and Responses
- Global Maternal and Child Health
- Pneumonia and Respiratory Infections
- Infectious Diseases and Mycology
- Drug-Induced Hepatotoxicity and Protection
- Hepatitis C virus research
- HIV Research and Treatment
- vaccines and immunoinformatics approaches
- Meta-analysis and systematic reviews
- Maternal and Perinatal Health Interventions
- Assisted Reproductive Technology and Twin Pregnancy
- HIV/AIDS drug development and treatment
- Vaccine Coverage and Hesitancy
- Genomics and Rare Diseases
- Chronic Disease Management Strategies
- HIV-related health complications and treatments
- Machine Learning in Healthcare
Sokoine University of Agriculture
2024-2025
University of Botswana
2016-2023
United States Agency for International Development
2022
Faculty (United Kingdom)
2020
University of the Witwatersrand
2019-2020
Faculty of Public Health
2020
Botswana Harvard AIDS Institute Partnership
2011
Botho University
2010
Objective: Thirty-six months of isoniazid preventive therapy (36IPT) was superior to 6 IPT (6IPT) in preventing tuberculosis (TB) among HIV-infected adults Botswana. We assessed the posttrial durability this benefit. Design: A 36-month double-blind placebo controlled trial (1 : 1 randomization) with recruitment between November 2004 and July 2006 observation until June 2011. Methods: One thousand, nine hundred ninety-five participants were followed eight public health clinics. Twenty-four...
BACKGROUND: Shorter but effective tuberculosis treatment regimens would be of value to the community. High-dose rifampicin has been associated with more rapid and secure lung sterilization may enable shorter regimens. METHODS: We randomly assigned adults who were given a diagnosis rifampicin-susceptible pulmonary 6-month control regimen, similar 4-month regimen at 1200 mg/d (study 1 [SR1]), or 1800 2 [SR2]). Sputum specimens collected regular intervals. The primary end point was composite...
To describe reasons for exclusion from isoniazid tuberculosis preventive therapy (IPT) and outcomes of persons living with HIV (PLWH) during 6 months IPT.In a clinical trial conducted in government clinics, first screening (screen 1) used National IPT Program guidelines second 2) was specific. Adherence defined as attending monthly visits.Between 2004 2006, at 4018 visits, 2934 (73%) PLWH met screen 1 criteria; 1995 (68%) 2 criteria were enrolled. Major illness (66%) abnormal chest...
Background Prior studies that used Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO)-trained African giant pouched rats reported an annual average of 40% increase in sputum-smear-positive tuberculosis (TB) detection. Sputum-smear microscopy (smear) is being replaced by Xpert MTB/RIF (Xpert)-based diagnostic algorithms many countries. We evaluated the incremental values rat-based case detection over smear and Xpert. Methods From January to December 2023, sputum samples were...
Little is known about the incidence of isoniazid-associated hepatitis in HIV-infected Africans who receive both isoniazid preventive therapy (IPT) and antiretroviral (ART).To assess rate risk factors for (INH)-associated persons living with HIV (PLWH) during IPT.PLWH recruited a clinical trial received 6 months open-label, daily, self-administered INH at public health clinics. At screening PLWH were excluded if they had any cough, weight loss, night sweats, or other illness. Alcohol abuse...
Background Non-tuberculous mycobacteria (NTM) can cause pulmonary infection and disease especially among people living with HIV (PLHIV). PLHIV NTM may clinically present one of the four symptoms consistent tuberculosis (TB). We describe prevalence Mycobacterium complex (MTBC) isolated who presented for care treatment. Methods All patients presenting treatment services at 22 clinical sites in Botswana were offered screening TB recruited. Patients had ≥1 symptom asked to submit sputa Xpert...
In 2011, the Botswana National Tuberculosis Program adopted World Health Organization guidelines and introduced Xpert MTB/RIF (Xpert) assay to support intensified case finding among people living with HIV enrolling in care. An evaluation was designed assess performance under operational conditions inform national scale-up.Xpert implemented from August 2012 through November 2014 13 GeneXpert instruments (GeneXpert) deployed a phased approach over nine months: centralized laboratory four...
In 2012, as a pilot for Botswana’s national Xpert MTB/RIF (Xpert) rollout plans, intensified tuberculosis (TB) case finding (ICF) activities were strengthened at 22 HIV treatment clinics prior to phased activation of 13 instruments. Together, the ICF intervention and are referred “Xpert package”. The evaluation, called Package Rollout Evaluation using Stepped-wedge design (XPRES), has two key objectives: (1) compare sensitivity microscopy-based Xpert-based pulmonary TB diagnostic algorithms...
Abstract Background African giant pouched rats, trained by Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO), have demonstrated their ability to detect tuberculosis (TB) from sputum. We assessed rat-based case detection and compared the mycobacterium bacillary load (MTB-load) in children versus adults. Methods From January–December 2022, samples were collected prospectively 69 Directly Observed Therapy (DOT) facilities’ presumed TB patients. Using an average of five APOPO...
Background Among people living with HIV (PLHIV), more flexible and sensitive tuberculosis (TB) screening tools capable of detecting both symptomatic subclinical active TB are needed to (1) reduce morbidity mortality from undiagnosed TB; (2) facilitate scale-up preventive therapy (TPT) while reducing inappropriate prescription TPT PLHIV (3) allow for differentiated HIV–TB care. Methods findings We used Botswana XPRES trial data adult clinic enrollees collected during 2012 2015 develop a...
Eight public health clinics in Gaborone and Francistown, Botswana.To describe the characteristics outcomes of incident tuberculosis (TB) cases human immunodeficiency virus (HIV) infected adults exposed to isoniazid preventive therapy (IPT) with access antiretroviral anti-tuberculosis treatment.In 1995 HIV-infected adults, TB disease was excluded before commencing IPT. During after receipt 6 or 36 months IPT, symptomatic participants were evaluated using chest radiographs, sputum microscopy,...
Twenty-two human immunodeficiency virus (HIV) clinics in Botswana.To compare sputum collection rates, quality and volume, tuberculosis (TB) diagnosis rates before after field efforts to improve among individuals newly diagnosed with HIV TB symptoms.Newly living attending 22 Botswana were screened for from August 2012 March 2014. Starting May 2013, a intervention composed of the introduction tracking log presumed patients, patient instructions induction was implemented.Prior intervention,...
Introduction: the World Health Organization endorsed (2010) use of Xpert MTB/RIF and countries are shifting from smear microscopy (smear)-based to MTB/RIF-based tuberculosis (TB) diagnostic algorithms. As with smear, sputum quality may predict likelihood obtaining a bacteriologically-confirmed TB when using MTB/RIF.
Xpert® MTB/RIF (Xpert) has high sensitivity for diagnosing tuberculosis (TB) compared to sputum-smear microscopy (smear) and can reduce time-to-diagnosis, time-to-treatment potentially unfavorable patient-level treatment outcome.People living with HIV (PLHIV) initiating antiretroviral therapy at 22 clinics were enrolled underwent systematic screening TB (August 2012-November 2014). GeneXpert instruments deployed following a stepped-wedge design 13 centers from October 2012-June 2013....
Abstract Background Undiagnosed tuberculosis (TB) remains the most common cause of HIV-related mortality. Xpert MTB/RIF (Xpert) is being rolled out globally to improve TB diagnostic capacity. However, previous impact trials have reported that health system weaknesses blunted this improved tool. During phased rollout in Botswana, we evaluated a package interventions comprising (1) additional support for intensified case finding (ICF), (2) active tracing patients missing clinic appointments...
Background Patients with non-tuberculous mycobacteria (NTM) or Mycobacterium tuberculosis (MTB) pulmonary disease may have similar clinical presentation. The potential for misdiagnosis and inappropriate treatment exists in settings limited testing capacity Xpert® MTB/RIF (Xpert), phenotypic culture NTM speciation. We describe outcomes among people living HIV (PLHIV) who received anti-tuberculosis were found to MTB positive sputum cultures. Methods PLHIV attending one of the 22 participating...
Seven health facilities with antenatal care (ANC) clinics in two districts near Gaborone, Botswana.To determine 1) the prevalence of tuberculosis (TB) and HIV-TB co-infection pregnancy, 2) sensitivities symptomatic TB screening Xpert testing against gold standard culture.This was a cross-sectional study. Pregnant women were randomly enrolled screened using symptoms. HIV status determined from ANC clinics' client records. Two sputum specimens collected all clients each tested Xpert® culture...
SUMMARY Background Globally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative diagnostic test result. Understanding factors associated with clinicians’ decisions to initiate treatment for individuals results is critical predicting the potential impact new diagnostics. Methods We performed systematic review and individual patient data meta-analysis using studies conducted between January/2010 December/2022 (PROSPERO:...