Browsing by Author "Davis, J. L."
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Item Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial(BMJ Open, 2022) Armstrong-Hough, Mari; Ggita, Joseph; Gupta, Amanda J.; Shelby, Tyler; Nangendo, Joanita; Okello Ayen, Daniel; Davis, J. L.; Katamba, AchillesHIV status awareness is important for household contacts of patients with tuberculosis (TB). Home HIV testing during TB contact investigation increases HIV status awareness. Social interactions during home visits may influence perceived stigma and uptake of HIV testing. We designed an intervention to normalise and facilitate uptake of home HIV testing with five components: guided selection of first tester; prosocial invitation scripts; opt-out framing; optional sharing of decisions to test; and masking of decisions not to test. Methods and analysis We will evaluate the intervention effect in a household-randomised controlled trial. The primary aim is to assess whether contacts offered HIV testing using the norming strategy will accept HIV testing more often than those offered testing using standard strategies. Approximately 198 households will be enrolled through three public health facilities in Kampala, Uganda. Households will be randomised to receive the norming or standard strategy and visited by a community health worker (CHW) assigned to that strategy. Eligible contacts ≥15 years will be offered optional, free, home HIV testing. The primary outcome, proportion of contacts accepting HIV testing, will be assessed by CHWs and analysed using an intention-to- treat approach. Secondary outcomes will be changes in perceived HIV stigma, changes in perceived TB stigma, effects of perceived HIV stigma on HIV test uptake, effects of perceived TB stigma on HIV test uptake and proportions of first-invited contacts who accept HIV testing. Results will inform new, scalable strategies for delivering HIV testing. Ethics and dissemination This study was approved by the Yale Human Investigation Committee (2000024852), Makerere University School of Public Health Institutional Review Board (661) and Uganda National Council on Science and Technology (HS2567). All participants, including patients and their household contacts, will provide verbal informed consent. Results will be submitted to a peer-reviewed journal and disseminated to national stakeholders, including policy-makers and representatives of affected communities.Item 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.Item 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.Item 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, LaurenceThe 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.Item 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.