Center for Operations Research

Sarre-Union, France

Center for Operations Research

Sarre-Union, France
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Satyanarayana S.,International Union against Tuberculosis and Lung Disease The Union | Satyanarayana S.,Center for Operations Research | Nair S.A.,International Union against Tuberculosis and Lung Disease The Union | Chadha S.S.,International Union against Tuberculosis and Lung Disease The Union | And 9 more authors.
PLoS ONE | Year: 2011

Background: Tuberculosis (TB) notification in India by the Revised National TB Control Programme (RNTCP) provides information on TB patients registered for treatment from the programme. There is limited information about the proportion of patients treated for TB outside RNTCP and where these patients access their treatment. Objectives: To estimate the proportion of patients accessing TB treatment outside the RNTCP and to identify their basic demographic characteristics. Methods: A cross sectional community-based survey in 30 districts. Patients were identified through a door-to-door survey and interviewed using a semi-structured questionnaire. Results: Of the estimated 75,000 households enumerated, 73,249 households (97.6%) were visited. Of the 371,174 household members, 761 TB patients were identified (~205 cases per 100,000 populations). Data were collected from 609 (80%) TB patients of which 331 [54% (95% CI: 42-66%)] were determined to be taking treatment 'under DOTS/RNTCP'. The remaining 278 [46% (95% CI: 34-57%)] were on treatment from 'outside DOTS/RNTCP' sources and hence were unlikely to be part of the TB notification system. Patients who were accessing treatment from 'outside DOTS/RNTCP' were more likely to be patients from rural areas [adjusted Odds Ratio (aOR) 2.5, 95% CI (1.2-5.3)] and whose TB was diagnosed in a non-government health facility (aOR 14.0, 95% CI 7.9-24.9). Conclusions: This community-based survey found that nearly half of self-reported TB patients were missed by TB notification system in these districts. The study highlights the need for 1) Reviewing and revising the scope of the TB notification system, 2) Strengthening and monitoring health care delivery systems with periodic assessment of the reach and utilisation of the RNTCP services especially among rural communities, 3) Advocacy, communication and social mobilisation activities focused at rural communities with low household incomes and 4) Inclusive involvement of all health-care providers, especially providers of poor rural communities. © 2011 Satyanarayana et al.


Srinath S.,Center for Operations Research | Sharath B.,World Health Organization | Santosha K.,Impact Health Solutions | Chadha S.S.,World Health Organization | And 6 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2011

SETTING: The Government of India's Revised National Tuberculosis Control Programme (RNTCP), Andhra Pradesh, South India. OBJECTIVES: To study the basic characteristics and treatment outcomes of tuberculosis (TB) patients classified as 'retreatment others' and compare their treatment outcomes with smear-positive retreatment TB cases (relapse, failure, and treatment after default [TAD]). DESIGN: Retrospective record and report review of a patient cohort (n = 1237) registered as 'retreatment others' under the RNTCP from July to September 2008. RESULTS: Of 1009 patient records of 'retreatment others' reviewed, 674 (67%) were males, 892 (88%) were aged 15-64 years, 847 (84%) were pulmonary sputum smear-negative, 843 (84%) had unknown human immunodeficiency virus (HIV) status and 55 (5.5%) were HIV-positive. All patients were treated with the RNTCP intermittent (thrice weekly) retreatment regimen. Eighty per cent were successfully treated (cured plus treatment completed). Successful outcomes were higher in females (84%), in patients with extra-pulmonary TB (87%) and in HIV-negative patients (87%). The treatment outcomes were significantly better for 'retreatment others' (P < 0.05) than among the sputum smear-positive retreatment cases (78% for relapses, 59% for failures and 73% for TAD). CONCLUSIONS: 'Retreatment others' were predominantly sputum smear-negative TB, with significantly better treatment outcomes than among smear-positive retreatment patients. Future studies may assess the accuracy of the diagnoses and factors contributing to the occurrence of 'retreatment others'. © 2011 The Union.


Satyanarayana S.,McGill University | Satyanarayana S.,Center for Operations Research | Subbaraman R.,Harvard University | Subbaraman R.,Action and Research | And 13 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2015

BACKGROUND: While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS: We searched multiple sources to identify studies (2000-2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULT S : Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS: Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India. © 2015 The Union.


News Article | February 17, 2017
Site: www.eurekalert.org

The 2016 Zika virus outbreak, along with recent outbreaks of SARS, bird flu, H1N1 and Ebola, underscore the importance of being prepared for and responding quickly to infectious diseases. Zika, in particular, poses unique challenges, since its associated birth defects and lack of preventive treatment currently threaten over 60 countries. During pandemics, scientists must race to investigate infection mechanisms, facilitate early detection and apply effective mitigations. Resources and policies for scientific, clinical and technical advances must be coordinated to enable rapid understanding of all aspects of an outbreak in order to minimize damaging impacts. Eva Lee, professor in the H. Milton Stewart School of Industrial & Systems Engineering at Georgia Tech and director of the Center for Operations Research in Medicine and Healthcare, has developed a biological-behavioral-operational computer model to help policy makers choose the best intervention strategies to rapidly contain an infectious disease outbreak. Her analysis covers the dynamics of disease transmission across different environments and social settings. The modeling system gives on-the-ground policymakers critical information about how to mitigate infection, monitor risk and trace disease during a pandemic. Lee presented findings and policy implications from her research on Feb. 16, 2017, in a briefing at the annual meeting of the American Association for the Advancement of Science (AAAS) in Boston, Mass. The research has been sponsored in part by the National Science Foundation (NSF) and the Centers for Disease Control and Prevention (CDC). Lee's presentation gave the results for Zika using her model, described by public health experts as "a digital disease surveillance and response" tool. The tool, ASSURE, can use many types of data, including biosurveillance, environmental, climate, viral, host, human behavior and social factors. If genetic information for the disease carriers are available, they also can be incorporated. Lee explained how the modeling system provides the ability to predict disease spread, assess risk and determine effective containment methods. In addition, it can help public health leaders optimize deployment of limited resources to help prevent and reduce the extent of future outbreaks. "The containment of pandemics is fundamental to preventing a global epidemic," said Lee. "ASSURE is a computational modeling tool designed for real-time support. By accepting real-time data, the model produces predictions that are customized to reflect a specific environment, policy and human behavior on the ground." Referring to data related to the Zika outbreak in Brazil, Lee discussed which containment approaches are most effective there. Her model shows that the easiest and most productive way to contain the outbreak in Brazil is to the reduce the biting rate of mosquitoes by using insect repellents/mosquito-wristbands, wearing long-sleeved shirts and long pants, and employing air conditioning and window/door screens to keep mosquitoes out. The result is practical. For example, the model demonstrates that only 20 percent compliance can reduce the total infection by half. This strategy is more successful than just widely applying insecticide and lasers to kill mosquitos. The model offers policymakers a decision-support framework to estimate the cost-effectiveness of each prevention measure. The modeling system also underscores the importance of early intervention by revealing the timing of different interventions and associated outcomes. "Knowing when to respond and how it affects the outcome is essential," Lee said. Lee has shared some of these findings with federal officials, who recommended implementation of her resulting policies and strategies for Puerto Rico. She is also working with public health leaders in Houston, Texas, to identify high-risk areas and to optimize local surveillance and intervention. Lee's system can be applied to help contain a wide variety of epidemics, including not only Zika but also dengue, Ebola, and many other types. "The modeling framework accommodates various transmission mechanisms. This allows public health officials to adapt rapidly to changing disease environments and different emerging epidemics," said Lee. As part of a continuing research effort, Lee is working with vaccinologists on vaccine immunity prediction to permit faster design and evaluation of new and emerging vaccines and to identify individuals either most likely or least likely to be protected by a vaccine. An applied mathematician and modeling innovator, Lee has traveled to hot spots around the world as an advisor in response to public health catastrophes. She has long partnered with the CDC on medical preparedness and emergency response. Since 2015, she served on the National Preparedness and Response Science Board (NPRSB), the federal committee that provides advice and guidance to the U.S. Department of Health and Human Services (HHS). The news briefing precedes the panel session Lee will lead entitled "Strategies for Public Health Pandemics: Science, Clinical Practice, and Policy," to take place on Feb. 18, 2017 at the AAAS annual meeting. Other speakers on the panel include Helder Nakaya from the University of São Paulo, who will discuss systems immunology and understanding the molecular mechanisms of immunity to infectious diseases. Mark Mulligan of the Emory University Vaccine Research Center will speak on clinical practice in the new era of global pandemics.


Pothukuchi M.,Siddhartha Medical College | Nagaraja S.B.,WHO RNTCP Technical Assistance Project andhra Pradesh | Kelamane S.,WHO RNTCP Technical Assistance Project andhra Pradesh | Satyanarayana S.,Center for Operations Research | And 4 more authors.
PLoS ONE | Year: 2011

Background: Under India's Revised National Tuberculosis Control Programme (RNTCP), all household contacts of sputum smear positive Pulmonary Tuberculosis (PTB) patients are screened for TB. In the absence of active TB disease, household contacts aged <6 years are eligible for Isoniazid Preventive Therapy (IPT) (5 milligrams/kilogram body weight/day) for 6 months. Objectives: To estimate the number of household contacts aged <6 years, of sputum smear positive PTB patients registered for treatment under RNTCP from April to June'2008 in Krishna District, to assess the extent to which they are screened for TB disease and in its absence initiated on IPT. Methods: A cross sectional study was conducted. Households of all smear positive PTB cases (n = 848) registered for treatment from April to June'2008 were included. Data on the number of household contacts aged <6 years, the extent to which they were screened for TB disease, and the status of initiation of IPT, was collected. Results: Households of 825 (97%) patients were visited, and 172 household contacts aged <6 years were identified. Of them, 116 (67%) were evaluated for TB disease; none were found to be TB diseased and 97 (84%) contacts were initiated on IPT and 19 (16%) contacts were not initiated on IPT due to shortage of INH tablets in peripheral health centers. The reasons for non-evaluation of the remaining eligible children (n = 56, 33%) include no home visit by the health staff in 25 contacts, home visit done but not evaluated in 31 contacts. House-hold contacts in rural areas were less likely to be evaluated and initiated on IPT [risk ratio 6.65 (95% CI; 3.06-14.42)]. Conclusion: Contact screening and IPT implementation under routine programmatic conditions is sub-optimal. There is an urgent need to sensitize all concerned programme staff on its importance and establishment of mechanisms for rigorous monitoring. © 2011 Pothukuchi et al.


PubMed | Directorate of Health, Revised National Tuberculosis Control Programme Technical Assistance Project, London School of Hygiene and Tropical Medicine, International Union Against Tuberculosis and Lung Disease The Union and 2 more.
Type: Journal Article | Journal: Public health action | Year: 2015

To assess response to anti-tuberculosis treatment as per national guidelines, a retrospective record review was undertaken in four districts of Andhra Pradesh, India, in December 2009 to determine whether pulmonary tuberculosis (PTB) patients reported as successfully treated (cured or treatment completed) underwent all scheduled follow-up sputum smear examinations. In a quarterly cohort of 3000 PTB patients reported as successfully treated, 1847 (61.5%) underwent all follow-up sputum examinations, with a higher proportion of new cases (65%) than retreatment cases (45%). The mid-continuation phase follow-up sputum examinations were commonly missed, and 11% patients had not undergone end-of-treatment follow-up sputum examinations.


PubMed | Center for Operations Research
Type: Journal Article | Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease | Year: 2011

The Government of Indias Revised National Tuberculosis Control Programme (RNTCP), Andhra Pradesh, South India.To study the basic characteristics and treatment outcomes of tuberculosis (TB) patients classified as retreatment others and compare their treatment outcomes with smear-positive retreatment TB cases (relapse, failure, and treatment after default [TAD]).Retrospective record and report review of a patient cohort (n = 1237) registered as retreatment others under the RNTCP from July to September 2008.Of 1009 patient records of retreatment others reviewed, 674 (67%) were males, 892 (88%) were aged 15-64 years, 847 (84%) were pulmonary sputum smear-negative, 843 (84%) had unknown human immunodeficiency virus (HIV) status and 55 (5.5%) were HIV-positive. All patients were treated with the RNTCP intermittent (thrice weekly) retreatment regimen. Eighty per cent were successfully treated (cured plus treatment completed). Successful outcomes were higher in females (84%), in patients with extra-pulmonary TB (87%) and in HIV-negative patients (87%). The treatment outcomes were significantly better for retreatment others (P < 0.05) than among the sputum smear-positive retreatment cases (78% for relapses, 59% for failures and 73% for TAD).Retreatment others were predominantly sputum smear-negative TB, with significantly better treatment outcomes than among smear-positive retreatment patients. Future studies may assess the accuracy of the diagnoses and factors contributing to the occurrence of retreatment others.

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