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Gaborone, Botswana

Quinley K.E.,University of Pennsylvania | Gormley R.H.,University of Pennsylvania | Ratcliffe S.J.,University of Pennsylvania | Shih T.,Click Diagnostics | And 4 more authors.
Journal of Telemedicine and Telecare | Year: 2011

Visual inspection of the cervix with application of 4% acetic acid (VIA) is an inexpensive alternative to cytology-based screening in areas where resources are limited, such as in many developing countries. We have examined the diagnostic agreement between off-site (remote) expert diagnosis using photographs of the cervix (photographic inspection with acetic acid, PIA) and in-person VIA. The images for remote evaluation were taken with a mobile phone and transmitted by MMS. The study population consisted of 95 HIV-positive women in Gaborone, Botswana. An expert gynaecologist made a definitive positive or negative reading on the PIA results of 64 out of the 95 women whose PIA images were also read by the nurse midwives. The remaining 31 PIA images were deemed insufficient in quality for a reading by the expert gynaecologist. The positive nurse PIA readings were concordant with the positive expert PIA readings in 82% of cases, and the negative PIA readings between the two groups were fully concordant in 89% of cases. These results suggest that mobile telemedicine may be useful to improve access of women in remote areas to cervical cancer screening utilizing the VIA 'see-and-treat' method.

Hafkin J.,University of Pennsylvania | Modongo C.,Botswana UPenn Partnership | Newcomb C.,University of Pennsylvania | Lowenthal E.,Childrens Hospital of Philadelphia | And 4 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2013

SETTING: The impact of the human immunodeficiency virus (HIV) on multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in sub-Saharan Africa, where extensive rollout of highly active antiretroviral therapy (HAART) has occurred, remains unclear. OBJECTIVE: To compare the time to initial culture conversion among patients with and those without HIV infection in a setting of individualized MDR-TB care in Botswana. DESIGN: Prospective cohort study of MDR-TB patients receiving ambulatory, integrated TB-HIV care at two public clinics in Botswana. The time to culture conversion was compared by HIV status using Cox proportional hazard ratios (HRs). RESULTS: A total of 40 HIV-infected and 30 non-HIV-infected patients with MDR-TB and follow-up cultures were identified. The median time to initial culture conversion was 78 days (interquartile range [IQR] 42-186) for HIV-infected and 95 days (IQR 70-133) for non-HIV-infected individuals (log rank P > 0.5; unadjusted HR 0.9, 95%CI 0.5-1.5). Adjusting for age, sex, treatment history and number of active anti-tuberculosis drugs did not change this result (adjusted HR 0.8, 95%CI 0.4-1.4). CONCLUSION: We found no difference in the proportion of or time to initial sputum culture conversion between an HIV-infected and a non-infected cohort of MDR-TB patients in Botswana, suggesting that outcomes may be comparable in similar settings with access to individualized anti-tuberculosis treatment and HAART. © 2013 The Union.

Littman-Quinn R.,Botswana UPenn Partnership | Luberti A.A.,Childrens Hospital of Philadelphia | Kovarik C.,University of Pennsylvania
Studies in Health Technology and Informatics | Year: 2013

Information retrieval (IR) practice is invaluable in health care, where the growth of medical knowledge has long surpassed human memory capabilities, and health care workers often have unmet information needs. While the information and communications technology (ICT) revolution is improving, IR in the Western world, the global digital divide has never been wider. Low and Middle Income Countries (LMICs) have the least advanced ICT infrastructure and service provision, and are also burdened with the majority of the world's health issues and severe shortages of health care workers. Initiatives utilizing mobile technology in healthcare and public health (mHealth) have shown potential at addressing these inequalities and challenges. Using Botswana as a reference point, this paper aims to broadly describe the healthcare and ICT challenges facing LMICs, the promise of mHealth as a field in health informatics, and then propose health informatics solutions that specifically address IR content and needs. One solution proposes utilizing Unstructured Supplementary Service Data (USSD) for accessing treatment guidelines, and the other solution outlines applications of smart devices for IR. © 2013 IMIA and IOS Press.

Littman-Quinn R.,Botswana UPenn Partnership | Mibenge C.,Botswana UPenn Partnership | Antwi C.,Botswana UPenn Partnership | Chandra A.,University of Botswana | Kovarik C.L.,University of Pennsylvania
Journal of Telemedicine and Telecare | Year: 2013

Although Botswana has recently been categorised as an upper middle income country, it is burdened by a scarcity of resources, both human and technological. There are barriers to patients' access to specialized care and healthcare providers' access to medical knowledge. Over the past three years, the Botswana-University of Pennsylvania Partnership (BUP) has piloted four mobile telemedicine projects in the specialties of women's health (cervical cancer screening utilizing visual inspection with acetic acid), radiology, oral medicine and dermatology. Mobile telemedicine has been used in 11 locations in Botswana, training a total of 24 clinicians and successfully contributing to the management of 643 cases. In addition to mobile telemedicine, BUP has initiated an m-learning programme with the University of Botswana School of Medicine. While successfully providing patients and providers with improved access to healthcare resources, the m-health projects have faced numerous technical and social challenges. These include malfunctioning mobile devices, unreliable IT infrastructure, accidental damage to mobile devices, and cultural misalignment between IT and healthcare providers. BUP has worked with its local partners to develop solutions to these problems. To ensure sustainability, m-health programmes must have strategic goals that are aligned with those of the national health and education system, and the initiatives must be owned and led by local stakeholders. Whenever possible, open source technology and local IT expertise and infrastructure should be employed.

Zetola N.M.,Botswana UPenn Partnership | Zetola N.M.,University of Pennsylvania | Zetola N.M.,University of Botswana | Shin S.S.,University of California at Los Angeles | And 8 more authors.
Journal of Clinical Microbiology | Year: 2014

The Xpert MTB/RIF (Xpert) assay is becoming a principal screening tool for diagnosing rifampin-resistant Mycobacterium tuberculosis complex (MTBC) infection. However, little is known about the performance of the Xpert assay in infections with both drug-sensitive and drug-resistant strains (mixed MTBC infections). We assessed the performance of the Xpert assay for detecting rifampin resistance using phenotypic drug sensitivity testing (DST) as the reference standard in 370 patients with microbiologically proven pulmonary tuberculosis. Mixed MTBC infections were identified genetically through 24-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analysis. Logistic regression was used to identify the factors associated with poor (defined as treatment failure, default, and death from any cause) or good (defined as cure or successful treatment completion) clinical outcomes. The analytic sensitivity of the Xpert assay for detecting rifampin resistance was assessed in vitro by testing cultures containing different ratios of drug-sensitive and drug-resistant organisms. Rifampin resistance was detected by the Xpert assay in 52 (14.1%) and by phenotypic DST in 55 (14.9%) patients. Mixed MTBC infections were identified in 37 (10.0%) patients. The Xpert assay was 92.7% (95% confidence interval [CI], 82.4% to 97.9%) sensitive for detecting rifampin resistance and 99.7% (95% CI, 98.3% to 99.9%) specific. When restricted to patients with mixed MTBC infections, Xpert sensitivity was 80.0% (95% CI, 56.3 to 94.3%). False-negative Xpert results (adjusted odds ratio [aOR], 6.6; 95% CI,1.2 to 48.2) and mixed MTBC infections (aOR, 6.5; 95% CI, 2.1 to 20.5) were strongly associated with poor clinical outcome. The Xpert assay failed to detect rifampin resistance in vitro when<90% of the organisms in the sample were rifampin resistant. Our study indicates that the Xpert assay has an increased false-negative rate for detecting rifampin resistance with mixed MTBC infections. In hyperendemic settings where mixed infections are common, the Xpert results might need further confirmation. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

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