Implementation science to improve the quality of tuberculosis diagnostic services in Uganda

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dc.contributor.authorCattamanchi, Adithya
dc.contributor.authorBerger, Christopher A.
dc.contributor.authorShete, Priya B.
dc.contributor.authorTuryahabwe, Stavia
dc.contributor.authorJoloba, Moses
dc.contributor.authorMoore, David A. J.
dc.contributor.authorDavis, Lucian J.
dc.contributor.authorKatamba, Achilles
dc.date.accessioned2023-01-18T17:29:08Z
dc.date.available2023-01-18T17:29:08Z
dc.date.issued2020
dc.description.abstractNucleic acid amplification tests such as Xpert MTB/RIF (Xpert) have the potential to revolutionize tuberculosis (TB) diagnostics and improve case finding in resource-poor settings. However, since its introduction over a decade ago in Uganda, there remain significant gaps along the cascade of care for patients undergoing TB diagnostic evaluation at peripheral health centers. We utilized a systematic, implementation science-based approach to identify key reasons at multiple levels for attrition along the TB diagnostic evaluation cascade of care. Provider- and health system-level barriers fit into four key thematic areas: human resources, material resources, service implementation, and service coordination. Patient-level barriers included the considerable costs and time required to complete health center visits. We developed a theory-informed strategy using the PRECEDE framework to target key barriers by streamlining TB diagnostic evaluation and facilitating continuous quality improvement. The resulting SIMPLE TB strategy involve four key components: 1) Single-sample LED fluorescence microscopy; 2) Daily sputum transport to Xpert testing sites; 3) Text message communication of Xpert results to health centers and patients; and 4) Performance feedback to health centers using a quality improvement framework. This combination of interventions was feasible to implement and significantly improved the provision of high-quality care for patients undergoing TB diagnostic evaluation. We conclude that achieving high coverage of Xpert testing services is not enough. Xpert scale-up should be accompanied by health system cointerventions to facilitate effective implementation and ensure that high quality care is delivered to patients.en_US
dc.identifier.citationCattamanchi, A., Berger, C. A., Shete, P. B., Turyahabwe, S., Joloba, M., Moore, D. A., ... & Katamba, A. (2020). Implementation science to improve the quality of tuberculosis diagnostic services in Uganda. Journal of clinical tuberculosis and other mycobacterial diseases, 18, 100136. https://doi.org/10.1016/j.jctube.2019.100136en_US
dc.identifier.otherhttps://doi.org/10.1016/j.jctube.2019.100136
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7046
dc.language.isoenen_US
dc.publisherJournal of clinical tuberculosis and other mycobacterial diseasesen_US
dc.subjectTuberculosisen_US
dc.subjectQuality improvementen_US
dc.subjectImplementation scienceen_US
dc.subjectNucleic acid amplification tests such as Xpert MTB/RIF (Xpert) have the potential to revolutionize tuberculosis (TB) diagnostics and improve case finding in resource-poor settings. However, since its introduction over a decade ago in Uganda, there remain significant gaps along the cascade of care for patients undergoing TB diagnostic evaluation at peripheral health centers. We utilized a systematic, implementation science-based approach to identify key reasons at multiple levels for attrition along the TB diagnostic evaluation cascade of care. Provider- and health system-level barriers fit into four key thematic areas: human resources, material resources, service implementation, and service coordination. Patient-level barriers included the considerable costs and time required to complete health center visits. We developed a theory-informed strategy using the PRECEDE framework to target key barriers by streamlining TB diagnostic evaluation and facilitating continuous quality improvement. The resulting SIMPLE TB strategy involve four key components: 1) Single-sample LED fluorescence microscopy; 2) Daily sputum transport to Xpert testing sites; 3) Text message communication of Xpert results to health centers and patients; and 4) Performance feedback to health centers using a quality improvement framework. This combination of interventions was feasible to implement and significantly improved the provision of high-quality care for patients undergoing TB diagnostic evaluation. We conclude that achieving high coverage of Xpert testing services is not enough. Xpert scale-up should be accompanied by health system cointerventions to facilitate effective implementation and ensure that high quality care is delivered to patients.en_US
dc.titleImplementation science to improve the quality of tuberculosis diagnostic services in Ugandaen_US
dc.typeArticleen_US
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