ArticleJournal of clinical tuberculosis and other mycobacterial diseases2020
Implementation science to improve the quality of tuberculosis diagnostic services in Uganda.
Article in Journal of clinical tuberculosis and other mycobacterial diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 4 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Implementation strategies to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests: evidence from a mixed-methods systematic review.BMJ global health · 2025Pooled it
- Xpert MTB/RIF Ultra assay for pulmonary tuberculosis and rifampicin resistance in adults and adolescents.The Cochrane database of systematic reviews · 2025Pooled it
- Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis of recipient and provider views.The Cochrane database of systematic reviews · 2022Pooled it
- Implementation of GeneXpert for TB Testing in Low- and Middle-Income Countries: A Systematic Review.Global health, science and practice · 2021Pooled it
- National Implementation of a Tuberculosis Sample Referral Network to Expand Access to Molecular Diagnosis in the Republic of Congo: Pilot Evaluation and Programmatic Analysis (2023-2025).Tropical medicine and infectious disease · 2026Article
- Operational performance of GeneXpert for tuberculosis diagnosis in West Java province, Indonesia: a public health evaluation.BMC health services research · 2026Article
- An implementation science framework to understand low coverage in mass dog rabies vaccination.PLoS neglected tropical diseases · 2025Article
- A process evaluation of an eHealth intervention to strengthen the circle of tuberculosis care in Shigatse, Tibet, China.PLOS global public health · 2025Article
- Decentralized TB diagnostic testing with Truenat MTB Plus and MTB-RIF Dx vs. hub-and-spoke GeneXpert MTB/RIF Ultra in Mozambique and Tanzania: a cost and cost-effectiveness analysis.PLOS global public health · 2025Article
- Rapid Phenotypic and Genotypic Antimicrobial Susceptibility Testing Approaches for Use in the Clinical Laboratory.Antibiotics (Basel, Switzerland) · 2024Review
- Mortality rate and associated factors among patients co-infected with drug resistant tuberculosis/HIV at Mulago National Referral Hospital, Uganda, a retrospective cohort study.PLOS global public health · 2023Article
- Article
- Impact of on-site Xpert on TB diagnosis and mortality trends in Uganda.Public health action · 2022Article
- Reimagining the status quo: How close are we to rapid sputum-free tuberculosis diagnostics for all?EBioMedicine · 2022Review
- Core components of a Community of Practice to improve community health worker performance: a qualitative study.Implementation science communications · 2022Article
- A Multi-Faceted Approach to Tuberculosis Active Case Finding among Remote Riverine Communities in Southern Nigeria.International journal of environmental research and public health · 2021Article
- Patient Perspectives and Willingness to Accept Incentives for Tuberculosis Diagnostic Evaluation in Uganda.Value in health regional issues · 2021Article
- Improving the quality of tuberculosis care in the post-pandemic world.Journal of clinical tuberculosis and other mycobacterial diseases · 2021Article
- Improving quality is necessary to building a TB-free world: Lancet Commission on Tuberculosis.Journal of clinical tuberculosis and other mycobacterial diseases · 2020Review
- Surveillance for multi-drug and rifampicin resistant tuberculosis and treatment outcomes among previously treated persons with tuberculosis in the era of GeneXpert in rural eastern Uganda.Journal of clinical tuberculosis and other mycobacterial diseases · 2020Article
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
Nucleic acid amplification tests such as Xpert MTB/RIF (Xpert) have the potential to revolutionize tuberculosis (TB) diagnostics and improve case finding in resource-poor settings. However, since its introduction over a decade ago in Uganda, there remain significant gaps along the cascade of care for patients undergoing TB diagnostic evaluation at peripheral health centers. We utilized a systematic, implementation science-based approach to identify key reasons at multiple levels for attrition along the TB diagnostic evaluation cascade of care. Provider- and health system-level barriers fit into four key thematic areas: human resources, material resources, service implementation, and service coordination. Patient-level barriers included the considerable costs and time required to complete health center visits. We developed a theory-informed strategy using the PRECEDE framework to target key barriers by streamlining TB diagnostic evaluation and facilitating continuous quality improvement. The resulting SIMPLE TB strategy involve four key components: 1) Single-sample LED fluorescence microscopy; 2) Daily sputum transport to Xpert testing sites; 3) Text message communication of Xpert results to health centers and patients; and 4) Performance feedback to health centers using a quality improvement framework. This combination of interventions was feasible to implement and significantly improved the provision of high-quality care for patients undergoing TB diagnostic evaluation. We conclude that achieving high coverage of Xpert testing services is not enough. Xpert scale-up should be accompanied by health system co-interventions to facilitate effective implementation and ensure that high quality care is delivered to patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.