Browsing by Author "Dowdy, D.W."

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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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    Re: Severe Mental Illness At ART Initiation Is Associated With Worse Retention In Care Among HIV-Infected Ugandan Adults By JM Nachega et al. (2013), TMIH 18, pp 53–57
    (Tropical Medicine & International Health, 2014) Nakimuli, Mpungu E.; Dowdy, D.W.; Nachega, J.B.
    We thank Shailendra Kapoor for his commentary on our publication titled ‘Severe mental illness at antiretroviral therapy (ART) initiation is associated with worse retention in HIV care among Ugandan adults’ (Nachega et al. 2013). The primary goal of that work was to investigate the association of severe mental illness (SMI) with retention in HIV care. The substantial amount of research findings that point to an association between efavirenz use and psychiatric symptoms (Kenedi & Goforth 2011), and the report by Kapoor compelled us to carry out additional analyses to determine whether efavirenz use had any effect on our previously observed association between severe mental illness (SMI) and retention in HIV care.