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Feasibility of a streamlined tuberculosis diagnosis and treatment initiation strategy.

  • Author(s): 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
  • et al.
Abstract

Objective

To assess the feasibility of a streamlined strategy for improving tuberculosis (TB) diagnostic evaluation and treatment initiation among patients with presumed TB.

Design

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.

Results

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.

Conclusion

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.

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