Browsing by Author "Nalugwa, T."

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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.