Feasibility of a streamlined tuberculosis diagnosis and treatment initiation strategy.


Shete, PB; Nalugwa, T; Farr, K; Ojok, C; Nantale, M; Howlett, P; Haguma, P; Ochom, E; Mugabe, F; Joloba, M; Chaisson, LH; Dowdy, DW; Moore, D; Davis, JL; Katamba, A; Cattamanchi, A; (2017) Feasibility of a streamlined tuberculosis diagnosis and treatment initiation strategy. The international journal of tuberculosis and lung disease, 21 (7). pp. 746-752. ISSN 1027-3719 DOI: https://doi.org/10.5588/ijtld.16.0699

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Abstract

To assess the feasibility of a streamlined strategy for improving tuberculosis (TB) diagnostic evaluation and treatment initiation among patients with presumed TB. Single-arm interventional pilot study at five primary care health centers of a streamlined, SIngle-saMPLE (SIMPLE) TB diagnostic evaluation strategy: 1) examination of two smear results from a single spot sputum specimen using light-emitting diode fluorescence microscopy, and 2) daily transportation of smear-negative sputum samples to Xpert® MTB/RIF testing sites. Of 1212 adults who underwent sputum testing for TB, 99.6% had two smears examined from the spot sputum specimen. Sputum was transported for Xpert testing within 1 clinic day for 83% (907/1091) of the smear-negative patients. Of 157 (13%) patients with bacteriologically positive TB, 116 (74%) were identified using sputum smear microscopy and 41 (26%) using Xpert testing of smear-negative samples. Anti-tuberculosis treatment was initiated in 142 (90%) patients with bacteriologically positive TB, with a median time to treatment of 1 day for smear-positive patients and 6 days for smear-negative, Xpert-positive patients. The SIMPLE TB strategy led to successful incorporation of Xpert testing and rapid treatment initiation in the majority of patients with bacteriologically confirmed TB in a resource-limited setting.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: TB Centre
PubMed ID: 28633698
URI: http://researchonline.lshtm.ac.uk/id/eprint/3983580

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