Browsing by Person "Charalambous, Salome"

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Algorithm-guided empirical tuberculosis treatment for people with advanced HIV (TB Fast Track): An open-label, cluster-randomised trial
(Elsevier, 2019-11-11) Grant, Alison D.; Charalambous, Salome; Tlali, Mpho; Karat, Aaron S.; Dorman, Susan E.; Hoffmann, Christopher J.; Johnson, Suzanne; Vassall, Anna; Churchyard, Gavin J.; Fielding, Katherine L.
Background Tuberculosis, which is often undiagnosed, is the major cause of death among HIV-positive people. We aimed to test whether the use of a clinical algorithm enabling the initiation of empirical tuberculosis treatment by nurses in primary health-care clinics would reduce mortality compared with standard of care for adults with advanced HIV disease.
Autopsy prevalence of tuberculosis and other potentially treatable infections among adults with advanced HIV enrolled in out-patient care in South Africa
(PLOS, 2016-11-09) Karat, Aaron S.; Omar, Tanvier; von Gottberg, Anne; Tlali, Mpho; Chihota, Violet N.; Churchyard, Gavin J.; Fielding, Katherine L.; Johnson, Suzanne; Martinson, Neil A.; McCarthy, Kerrigan; Wolter, Nicole; Wong, Emily B.; Charalambous, Salome; Grant, Alison D.; Cardona, Pere-Joan
Background Early mortality among HIV-positive adults starting antiretroviral therapy (ART) remains high in resource-limited settings, with tuberculosis (TB) the leading cause of death. However, current methods to estimate TB-related deaths are inadequate and most autopsy studies do not adequately represent those attending primary health clinics (PHCs). This study aimed to determine the autopsy prevalence of TB and other infections in adults enrolled at South African PHCs in the context of a pragmatic trial of empiric TB treatment (“TB Fast Track”).
Health system determinants of tuberculosis mortality in South Africa: A causal loop model
(BMC, 2021-04-26) Osman, Muhammad; Karat, Aaron S.; Khan, Munira; Meehan, Sue-Ann; von Delft, Arne; Brey, Zameer; Charalambous, Salome; Hesseling, Anneke C.; Naidoo, Pren; Loveday, Marian
Background: Tuberculosis (TB) is a major public health concern in South Africa and TB-related mortality remains unacceptably high. Numerous clinical studies have examined the direct causes of TB-related mortality, but its wider, systemic drivers are less well understood. Applying systems thinking, we aimed to identify factors underlying TB mortality in South Africa and describe their relationships. At a meeting organised by the ‘Optimising TB Treatment Outcomes’ task team of the National TB Think Tank, we drew on the wide expertise of attendees to identify factors underlying TB mortality in South Africa. We generated a causal loop diagram to illustrate how these factors relate to each other. Results: Meeting attendees identified nine key variables: three ‘drivers’ (adequacy & availability of tools, implementation of guidelines, and the burden of bureaucracy); three ‘links’ (integration of health services, integration of data systems, and utilisation of prevention strategies); and three ‘outcomes’ (accessibility of services, patient empowerment, and socio-economic status). Through the development and refinement of the causal loop diagram, additional explanatory and linking variables were added and three important reinforcing loops identified. Loop 1, ‘Leadership and management for outcomes’ illustrated that poor leadership led to increased bureaucracy and reduced the accessibility of TB services, which increased TB-related mortality and reinforced poor leadership through patient empowerment. Loop 2, ‘Prevention and structural determinants’ describes the complex reinforcing loop between socio-economic status, patient empowerment, the poor uptake of TB and HIV prevention strategies and increasing TB mortality. Loop 3, ‘System capacity’ describes how fragmented leadership and limited resources compromise the workforce and the performance and accessibility of TB services, and how this negatively affects the demand for higher levels of stewardship. Conclusions: Strengthening leadership, reducing bureaucracy, improving integration across all levels of the system, increasing health care worker support, and using windows of opportunity to target points of leverage within the South African health system are needed to both strengthen the system and reduce TB mortality. Further refinement of this model may allow for the identification of additional areas of intervention.
Measuring mortality due to HIV-associated tuberculosis among adults in South Africa: Comparing verbal autopsy, minimally-invasive autopsy, and research data
(PLOS, 2017-03-23) Karat, Aaron S.; Tlali, Mpho; Fielding, Katherine L.; Charalambous, Salome; Chihota, Violet N.; Churchyard, Gavin J.; Hanifa, Yasmeen; Johnson, Suzanne; McCarthy, Kerrigan; Martinson, Neil A.; Omar, Tanvier; Kahn, Kathleen; Chandramohan, Daniel; Grant, Alison D.; Isaakidis, Petros
Background The World Health Organization (WHO) aims to reduce tuberculosis (TB) deaths by 95% by 2035; tracking progress requires accurate measurement of TB mortality. International Classification of Diseases (ICD) codes do not differentiate between HIV-associated TB and HIV more generally. Verbal autopsy (VA) is used to estimate cause of death (CoD) patterns but has mostly been validated against a suboptimal gold standard for HIV and TB. This study, conducted among HIV-positive adults, aimed to estimate the accuracy of VA in ascertaining TB and HIV CoD when compared to a reference standard derived from a variety of clinical sources including, in some, minimally-invasive autopsy (MIA).
Performance of verbal autopsy methods in estimating HIV-associated mortality among adults in South Africa
(BMJ, 2018-07-03) Karat, Aaron S.; Maraba, Noriah; Tlali, Mpho; Charalambous, Salome; Chihota, Violet N.; Churchyard, Gavin J.; Fielding, Katherine L.; Hanifa, Yasmeen; Johnson, Suzanne; McCarthy, Kerrigan M.; Kahn, Kathleen; Chandramohan, Daniel; Grant, Alison D.; Topp, Stephanie M.
Introduction Verbal autopsy (VA) can be integrated into civil registration and vital statistics systems, but its accuracy in determining HIV-associated causes of death (CoD) is uncertain. We assessed the sensitivity and specificity of VA questions in determining HIV status and antiretroviral therapy (ART) initiation and compared HIV-associated mortality fractions assigned by different VA interpretation methods.
Verbal autopsy-assigned causes of death among adults being investigated for TB in South Africa
(Oxford University Press, 2016-10-28) Maraba, Noriah; Karat, Aaron S.; McCarthy, Kerrigan; Churchyard, Gavin J.; Charalambous, Salome; Kahn, Kathleen; Grant, Alison D.; Chihota, Violet
Background: Adults being investigated for TB in South Africa experience high mortality, yet causes of death (CoD) are not well defined. We determined CoD in this population using verbal autopsy (VA), and compared HIV- and TB-associated CoD using physician-certified verbal autopsy (PCVA) and InterVA-4 software.