Browsing by Author "Boon, Saskia den"

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    Evaluating Tuberculosis Case Detection via Real-Time Monitoring of Tuberculosis Diagnostic Services
    (American journal of respiratory and critical care medicine, 2011) Davis, J. Lucian; Katamba, Achilles; Vasquez, Josh; Crawford, Erin; Sserwanga, Asadu; Kakeeto, Stella; Kizito, Fred; Dorsey, Grant; Boon, Saskia den; Vittinghoff, Eric; Huang, Laurence; Adatu, Francis; Kamya, Moses R.; Hopewell, Philip C.; Cattamanch, Adithya
    Tuberculosis case-detection rates are below internationally established targets in high-burden countries. Real-time monitoring and evaluation of adherence to widely endorsed standards of tuberculosis care might facilitate improved case finding. Objectives: To monitor and evaluate the quality of tuberculosis casedetection and management services in a low-income country with a high incidence of tuberculosis. Methods:We prospectively evaluated tuberculosis diagnostic services at five primary health-care facilities in Uganda for 1 year, after introducing a real-time, electronic performance-monitoring system. We collecteddataonevery clinicalencounter,andmeasuredquality using indicatorsderivedfromthe International StandardsofTuberculosisCare. Measurements and Main Results: In 2009, there were 62,909 adult primary-care visits.During the first quarter of 2009, clinicians referred only21%of patients with cough greater than or equal to 2 weeks for sputum smear microscopy and only 71% of patients with a positive sputum examination for tuberculosis treatment. These proportions increased to 53% and 84%, respectively, in the fourth quarter of 2009. The cumulative probability that a smear-positive patient with cough greater than or equal to 2 weeks would be appropriately evaluated and referred for treatment rose from 11% to 34% (P 5 0.005). The quarterly number of tuberculosis cases identified and prescribed treatment also increased four-fold, from 5 to 21. Conclusions: Pooradherence tointernationally acceptedstandards of tuberculosis care improved after introduction of real-time performance monitoring and was associated with increased tuberculosis case detection. Real-time monitoring and evaluation can strengthen health systems in low-income countries and facilitate operational research on the effectiveness and sustainability of interventions to improve tuberculosis case detection.
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    Test and Treat: A New Standard for Smear-Positive Tuberculosis
    (Journal of acquired immune deficiency syndromes, 2012) Davis, J. Lucian; Dowdy, David W.; Boon, Saskia den; Walter, Nicholas D.; Katamba, Achilles; Cattamanchi, Adithya
    Optimizing sputum smear microscopy, the principal method of tuberculosis (TB) diagnosis in high-burden settings around the world, is a critical priority for global TB control. To improve rates of testing, completion, and reporting, the World Health Organization (WHO) recently endorsed a policy of same-day diagnosis of TB by microscopy. Unfortunately, the implementation of this policy has emphasized same-day sputum collection alone, with patients required to return on a subsequent day to collect results. We use a simple decision analysis to demonstrate that the timing of results reporting has a greater impact on treatment initiation for smear-positive TB cases than the timing of specimen collection. Same-day diagnosis of smear-positive TB, including sputum collection and reporting of smear results, should be the new global standard.
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    The prevalence and clinical course of HIV-associated pulmonary cryptococcosis in Uganda
    (Journal of acquired immune deficiency syndromes, 2010) Yoo, Samuel D.; Worodria, William; Davis, J. L.; Cattamanchi, Adithya; Boon, Saskia den; Kyeyune, Rachel; Kisembo, Harriet; Huang, Laurence
    The prevalence and clinical course of pulmonary cryptococcosis in Sub-Saharan Africa are not well-described. Methods—Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between September 2007 and July 2008 with cough ≥ 2 weeks were enrolled. Patients with negative sputum smears for acid-fast bacilli were referred for bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii, and fungi. Patients were followed two and six months after hospital discharge. Results—Of 407 patients enrolled, 132 (32%) underwent bronchoscopy. Of 132 BAL fungal cultures, 15 (11%) grew Cryptococcus neoformans. None of the patients were suspected to have pulmonary cryptococcosis on admission. The median CD4 count among those with pulmonary cryptococcosis was 23 cells/μL (IQR 7–51). Of 13 patients who completed six-month follow-up, four died and nine were improved, including five who had started antiretroviral therapy (ART) but had not received antifungal medication. Conclusions—Pulmonary cryptococcosis is common in HIV-infected TB suspects in Uganda. Early initiation of ART in those with isolated pulmonary infection may improve outcomes, even without anti-fungal therapy. This finding suggests that some HIV-infected patients with C. neoformans isolated from respiratory samples may have colonization or localized infection.