Browsing by Author "Cattamanchi, A."

Now showing 1 - 4 of 4
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    Higher cost of implementing XpertW MTB/RIF in Ugandan peripheral settings: implications for cost-effectiveness
    (The international journal of tuberculosis and lung disease, 2016) Hsiang, E.; Little, K. M.; Haguma, P.; Hanrahan, C. F.; Katamba, A.; Cattamanchi, A.; Davis, J. L.; Vassall, A.; Dowdy, D.
    Initial cost-effectiveness evaluations of Xpertw MTB/RIF for tuberculosis (TB) diagnosis have not fully accounted for the realities of implementation in peripheral settings. OBJECTIVE : To evaluate costs and diagnostic outcomes of Xpert testing implemented at various health care levels in Uganda. DESIGN: We collected empirical cost data from five health centers utilizing Xpert for TB diagnosis, using an ingredients approach. We reviewed laboratory and patient records to assess outcomes at these sites and10 sites without Xpert.We also estimated incremental costeffectiveness of Xpert testing; our primary outcome was the incremental cost of Xpert testing per newly detected TB case. RESULT S : Themean unit cost of anXpert testwasUS$21 based on a mean monthly volume of 54 tests per site, although unit cost varied widely (US$16–58) and was primarily determined by testing volume. Total diagnostic costs were 2.4-fold higher in Xpert clinics than in non- Xpert clinics; however, Xpert only increased diagnoses by 12%. The diagnostic costs of Xpert averaged US$119 per newly detectedTB case, butwere as high asUS$885 at the center with the lowest volume of tests. CONCLUS ION: Xpert testing can detect TB cases at reasonable cost, but may double diagnostic budgets for relatively small gains, with cost-effectiveness deteriorating with lower testing volumes.
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    Multicomponent Strategy with Decentralized Molecular Testing for Tuberculosis
    (New England Journal of Medicine, 2021) Cattamanchi, A.; Reza, T.F.; Nalugwa, T.; Adams, K.; Nantale, M.; Oyuku, D.; Nabwire, S.; Babirye, D.; Turyahabwe, S.; Tucker, A.; Sohn, H.; Ferguson, O.; Thompson, R.; Shete, P.B.; Handley, M.A.; Ackerman, S.; Joloba, M.; Moore, D.A.J.; Davis, J.L.; Dowdy, D.W.; Fielding, K.; Katamba, A.
    Effective strategies are needed to facilitate the prompt diagnosis and treatment of tuberculosis in countries with a high burden of the disease. METHODS We conducted a cluster-randomized trial in which Ugandan community health centers were assigned to a multicomponent diagnostic strategy (on-site molecular testing for tuberculosis, guided restructuring of clinic workflows, and monthly feedback of quality metrics) or routine care (on-site sputum-smear microscopy and referral-based molecular testing). The primary outcome was the number of adults treated for confirmed tuberculosis within 14 days after presenting to the health center for evaluation during the 16-month intervention period. Secondary outcomes included completion of tuberculosis testing, same-day diagnosis, and sameday treatment. Outcomes were also assessed on the basis of proportions. RESULTS A total of 20 health centers underwent randomization, with 10 assigned to each group. Of 10,644 eligible adults (median age, 40 years) whose data were evaluated, 60.1% were women and 43.8% had human immunodeficiency virus infection. The intervention strategy led to a greater number of patients being treated for confirmed tuberculosis within 14 days after presentation (342 patients across 10 intervention health centers vs. 220 across 10 control health centers; adjusted rate ratio, 1.56; 95% confidence interval [CI], 1.21 to 2.01). More patients at intervention centers than at control centers completed tuberculosis testing (adjusted rate ratio, 1.85; 95% CI, 1.21 to 2.82), received a same-day diagnosis (adjusted rate ratio, 1.89; 95% CI, 1.39 to 2.56), and received same-day treatment for confirmed tuberculosis (adjusted rate ratio, 2.38; 95% CI, 1.57 to 3.61). Among 706 patients with confirmed tuberculosis, a higher proportion in the intervention group than in the control group were treated on the same day (adjusted rate ratio, 2.29; 95% CI, 1.23 to 4.25) or within 14 days after presentation (adjusted rate ratio, 1.22; 95% CI, 1.06 to 1.40). CONCLUSIONS A multicomponent diagnostic strategy that included on-site molecular testing plus implementation supports to address barriers to delivery of high-quality tuberculosis evaluation services led to greater numbers of patients being tested, receiving a diagnosis, and being treated for confirmed tuberculosis. (Funded by the National Heart, Lung, and Blood Institute; XPEL-TB ClinicalTrials.gov number, NCT03044158.)
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    Patterns of usage and preferences of users for tuberculosis related text messages and voice calls in Uganda
    (The International Journal of Tuberculosis and Lung Disease, 2018) Ggita, J. M.; Ojok, C.; Meyer, A. J.; Farr, K.; Shete, P. B.; Ochom, E.; Turimumahoro, P.; Babirye, D.; Mark, D.; Dowdy, D.; Ackerman, S.; Armstrong-Hough, M.; Nalugwa, T.; Ayakaka, I.; Moore, D.; Haberer, J. E.; Cattamanchi, A.; Katamba, A.; Davis, J. L.
    Little information exists about mobile phone usage or preferences for tuberculosis (TB) related health communications in Uganda. METHODS : We surveyed household contacts of TB patients in urban Kampala, Uganda, and clinic patients in rural central Uganda. Questions addressed mobile phone access, usage, and preferences for TB-related communications. We collected qualitative data about messaging preferences. RESULT S : We enrolled 145 contacts and 203 clinic attendees. Most contacts (58%) and clinic attendees (75%) owned a mobile phone, while 42% of contacts and 10% of clinic attendees shared one; 94% of contacts and clinic attendees knew how to receive a short messaging service (SMS) message, but only 59% of contacts aged745 years (vs. 96% of contacts aged ,45 years, P¼0.0001) did so. All contacts and 99% of clinic attendees were willing and capable of receiving personal- health communications by SMS. Among contacts, 55% preferred detailed messages disclosing test results, while 45% preferred simple messages requesting a clinic visit to disclose results. CONCLUS IONS : Most urban household TB contacts and rural clinic attendees reported having access to a mobile phone and willingness to receive TB-related personal-health communications by voice call or SMS. However, frequent phone sharing and variable messaging abilities and preferences suggest a need to tailor the design and monitoring of mHealth interventions to target recipients.
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    Using Geographic Analysis To Investigate Barriers To Tb Evaluation In Uganda
    (American Thoracic Society, 2012) Ross, J. M.; Cattamanchi, A.; Miller, C. R.; Katamba, A.; Davis, J. L.
    Identifying and treating cases of active tuberculosis (TB) represents a major challenge for international TB control, particularly in high-burden countries like Uganda, where only 61% of TB patients currently receive a diagnosis. In these settings, patients must travel to centralized health centers to complete the multi-day sputum collection and examination process. We sought to understand the impact of distance on the success of TB suspect evaluation in primary health centers in sub-Saharan Africa. Objectives: (1) To develop a measure of the distance traveled to clinic by patients suspected of TB for evaluation in rural Uganda; (2) To describe the relationship between distance traveled and the likelihood of completing TB evaluation. Methods: We collected data on TB evaluation services provided to all adults presenting with cough ≥ 2 weeks at six primary health centers in six districts of rural Uganda from January, 2009 to March, 2011. We calculated the distance from the geographic center of the patients’ home parish to the health clinic using Euclidean distance in ArcMap version 10 (ESRI, Redlands, CA). We measured the association between distance traveled and likelihood of completing evaluation for TB (≥1 positive, or ≥2 negative microscopic examinations of sputum) using logistic regression adjusted for clustering of data within health clinics. The Makerere University School of Medicine Research Ethics Committee approved the protocol. Results: Out of 182,657 patient encounters, 3528 adults (1.9%) were classified as TB suspects (cough ≥ 2 weeks). Sputum smear microscopy for AFB was ordered in 1916/3528 (54.3%) TB suspects. 1470/1916 (76.7%) TB suspects in whom sputum examination was ordered completed sputum evaluation. Median distance from health center to parish was 7.5 km (interquartile range 3.4 km-20.2 km). The distance from health center to home parish did not differ between those who completed TB evaluation and those who did not (OR 1.00 per 1 km increase, 95% CI 0.99-1.01), after accounting for clustering by clinic site. Conclusions: Euclidean distance from home to clinic does not predict completion of TB suspect evaluation in rural Uganda. Future studies should evaluate the influence of additional geographic factors, such as land cover, transportation networks, and travel costs, on access to TB diagnostic services.