ArticleJournal of acquired immune deficiency syndromes (1999)2016
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.
Article in Journal of acquired immune deficiency syndromes (1999), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 15 citations in OpenAlex.
- Missed opportunities for diagnosis and treatment in patients with TB symptoms: a systematic review.Public health action · 2022Review
- Tuberculosis diagnosis cascade in Blantyre, Malawi: a prospective cohort study.BMC infectious diseases · 2021Article
- Tuberculosis preventive treatment opportunities at antiretroviral therapy initiation and follow-up visits.Public health action · 2020Article
- Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium.Open forum infectious diseases · 2020Article
- Quality matters: Redefining child TB care with an emphasis on quality.Journal of clinical tuberculosis and other mycobacterial diseases · 2019Article
- Guidance for Studies Evaluating the Accuracy of Tuberculosis Triage Tests.The Journal of infectious diseases · 2019Article
- C-reactive protein as a screening test for HIV-associated pulmonary tuberculosis prior to antiretroviral therapy in South Africa.AIDS (London, England) · 2018Article
- Completion of the tuberculosis care cascade in a community-based HIV linkage-to-care study in South Africa and Uganda.Journal of the International AIDS Society · 2018Article
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThe 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.
methodsWe conducted a cohort analysis of new, antiretroviral therapy-naive, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012-September 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.
resultsOf 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%).
conclusionsThe 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.
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