Feasibility of a multifaceted intervention to improve treatment initiation among patients diagnosed with TB using Xpert MTB/RIF testing in Uganda
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
One in five patients diagnosed with TB in Uganda are not initiated on TB treatment within
two weeks of diagnosis. We evaluated a multifaceted intervention for improving TB treatment
initiation among patients diagnosed with TB using Xpert® MTB/RIF testing in Uganda.
Methods
This was a pre-post interventional study at one tertiary referral hospital. The intervention
was informed by the COM-B model and included; i) medical education sessions to improve
healthcare worker knowledge about the magnitude and consequences of pretreatment loss
to follow-up; ii) modified laboratory request forms to improve recording of patient contact
information; and iii) re-designed workflow processes to improve timeliness of sputum testing
and results dissemination. TB diagnostic process and outcome data were collected and
compared from the period before (June to August 2019) and after (October to December
2019) intervention initiation.
Results
In September 2019, four CME sessions were held at the hospital and were attended by 58
healthcare workers. During the study period, 1242 patients were evaluated by Xpert® MTB/
RIF testing at the hospital (679 pre and 557 post intervention). Median turnaround time for
sputum test results improved from 12 hours (IQR 4–46) in the pre-intervention period to 4
hours (IQR 3–6) in the post-intervention period. The proportion of patients started on treatment
within two weeks of diagnosis improved from 59% (40/68) to 89% (49/55) (difference
30%, 95% CI 14%-43%, p<0.01) while the proportion of patients receiving a same-day diagnosis increased from 7.4% (5/68) to 25% (14/55) (difference 17.6%, 95% CI 3.9%-
32.7%, p<0.01).
Conclusion
The multifaceted intervention was feasible and resulted in a higher proportion of patients initiating
TB treatment within two weeks of diagnosis.
Description
Keywords
Feasibility, Multifaceted intervention, Treatment initiation, Patients, TB, Xpert MTB/RIF testing
Citation
Zawedde-Muyanja S, Musaazi J, Castelnuovo B, Cattamanchi A, Katamba A, Manabe YC (2022) Feasibility of a multifaceted intervention to improve treatment initiation among patients diagnosed with TB using Xpert MTB/RIF testing in Uganda. PLoS ONE 17(6): e0265035. https://doi. org/10.1371/journal.pone.0265035