Implementation and Operational Research: Use of Symptom Screening and Sputum Microscopy Testing for Active Tuberculosis Case Detection Among HIV-Infected Patients in Real-World Clinical Practice in Uganda

被引:6
作者
Roy, Monika [1 ]
Muyindike, Winnie [2 ]
Vijayan, Tara [1 ]
Kanyesigye, Michael [2 ]
Bwana, Mwebesa [2 ]
Wenger, Megan [3 ]
Martin, Jeffrey [1 ]
Geng, Elvin [3 ]
机构
[1] Univ Calif San Francisco, San Francisco Gen Hosp, Div HIV ID & Global Med, Dept Med, San Francisco, CA USA
[2] Mbarara Univ Sci & Technol, Mbarara, Uganda
[3] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
关键词
HIV; tuberculosis; screening; implementation; ISONIAZID PREVENTIVE THERAPY; PULMONARY TUBERCULOSIS; DIAGNOSIS; BARRIERS; SERVICES; PEOPLE; DELAY;
D O I
10.1097/QAI.0000000000001067
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background:The uptake of intensified active TB case-finding among HIV-infected patients using symptom screening is not well understood. We evaluated the rate and completeness of each interim step in the TB pulmonary diagnostic cascade to understand real-world barriers to active TB case detection.Methods:We conducted a cohort analysis of new, antiretroviral therapy-naive, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012September 30, 2013). We used medical records to extract date of completion of each step in the diagnostic cascade: symptom screen, order, collection, processing, and result. Factors associated with lack of sputum order were evaluated using multivariate Poisson regression and chart review of 50 screen-positive patients.Results:Of 2613 patients, 2439 (93%) were screened for TB and 682 (28%) screened positive. Only 90 (13.2%) had a sputum order. Of this group, 83% completed the diagnostic cascade, 13% were diagnosed with TB, and 50% had a sputum result within 1 day of their visit. Sputum ordering was associated with WHO stage 3 or 4 HIV disease and greater number of symptoms. The main identifiable reasons for lack of sputum order in chart review were treatment of presumed malaria (51%) or bacterial infection (43%).Conclusions:The majority of newly enrolled HIV-infected patients who screened positive for suspected TB did not have a sputum order, and those who did were more likely to have more symptoms and advanced HIV disease. Further evaluation of provider behavior in the management of screen-positive patients could improve active TB case detection rates.
引用
收藏
页码:e86 / e91
页数:6
相关论文
共 17 条
  • [1] [Anonymous], 2011, Intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings
  • [2] Lessons learned during tuberculosis screening in public medical clinics in Francistown, Botswana
    Bloss, E.
    Makombe, R.
    Kip, E.
    Smit, M.
    Chirenda, J.
    Gammino, V. M.
    Creek, T.
    Oeltmann, J. E.
    [J]. INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, 2012, 16 (08) : 1030 - 1032
  • [3] Burmen B, 2012, 19 INT AIDS C WASH D
  • [4] An Algorithm for Tuberculosis Screening and Diagnosis in People with HIV
    Cain, Kevin P.
    McCarthy, Kimberly D.
    Heilig, Charles M.
    Monkongdee, Patama
    Tasaneeyapan, Theerawit
    Kanara, Nong
    Kimerling, Michael E.
    Chheng, Phalkun
    Thai, Sopheak
    Sar, Borann
    Phanuphak, Praphan
    Teeratakulpisarn, Nipat
    Phanuphak, Nittaya
    Nguyen Huy Dung
    Hoang Thi Quy
    Le Hung Thai
    Varma, Jay K.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2010, 362 (08) : 707 - 716
  • [5] Health worker perspectives on barriers to delivery of routine tuberculosis diagnostic evaluation services in Uganda: a qualitative study to guide clinic-based interventions
    Cattamanchi, Adithya
    Miller, Cecily R.
    Tapley, Asa
    Haguma, Priscilla
    Ochom, Emmanuel
    Ackerman, Sara
    Davis, J. Lucian
    Katamba, Achilles
    Handley, Margaret A.
    [J]. BMC HEALTH SERVICES RESEARCH, 2015, 15
  • [6] Provider-initiated symptom screening for tuberculosis in Zimbabwe: diagnostic value and the effect of HIV status
    Corbett, Elizabeth L.
    Zezai, Abbas
    Cheung, Yin Bun
    Bandason, Tsitsi
    Dauya, Ethel
    Munyati, Shungu S.
    Butterworth, Anthony E.
    Rusikaniko, Simba
    Churchyard, Gavin J.
    Mungofa, Stanley
    Hayes, Richard J.
    Mason, Peter R.
    [J]. BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2010, 88 (01) : 13 - 21
  • [7] Test and Treat: A New Standard for Smear-Positive Tuberculosis
    Davis, J. Lucian
    Dowdy, David W.
    den Boon, Saskia
    Walter, Nicholas D.
    Katamba, Achilles
    Cattamanchi, Adithya
    [J]. JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2012, 61 (01) : E6 - E8
  • [8] Evaluating Tuberculosis Case Detection via Real-Time Monitoring of Tuberculosis Diagnostic Services
    Davis, J. Lucian
    Katamba, Achilles
    Vasquez, Josh
    Crawford, Erin
    Sserwanga, Asadu
    Kakeeto, Stella
    Kizito, Fred
    Dorsey, Grant
    den Boon, Saskia
    Vittinghoff, Eric
    Huang, Laurence
    Adatu, Francis
    Kamya, Moses R.
    Hopewell, Philip C.
    Cattamanchi, Adithya
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2011, 184 (03) : 362 - 367
  • [9] Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV
    Finnie, Ramona K. C.
    Khoza, Lunic Base
    van den Borne, Bart
    Mabunda, Tiyane
    Abotchie, Peter
    Mullen, Patricia D.
    [J]. TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2011, 16 (04) : 394 - 411
  • [10] Development of a Standardized Screening Rule for Tuberculosis in People Living with HIV in Resource-Constrained Settings: Individual Participant Data Meta-analysis of Observational Studies
    Getahun, Haileyesus
    Kittikraisak, Wanitchaya
    Heilig, Charles M.
    Corbett, Elizabeth L.
    Ayles, Helen
    Cain, Kevin P.
    Grant, Alison D.
    Churchyard, Gavin J.
    Kimerling, Michael
    Shah, Sarita
    Lawn, Stephen D.
    Wood, Robin
    Maartens, Gary
    Granich, Reuben
    Date, Anand A.
    Varma, Jay K.
    [J]. PLOS MEDICINE, 2011, 8 (01):