Multicomponent Strategy with Decentralized Molecular Testing for Tuberculosis

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dc.contributor.authorCattamanchi, A.
dc.contributor.authorReza, T.F.
dc.contributor.authorNalugwa, T.
dc.contributor.authorAdams, K.
dc.contributor.authorNantale, M.
dc.contributor.authorOyuku, D.
dc.contributor.authorNabwire, S.
dc.contributor.authorBabirye, D.
dc.contributor.authorTuryahabwe, S.
dc.contributor.authorTucker, A.
dc.contributor.authorSohn, H.
dc.contributor.authorFerguson, O.
dc.contributor.authorThompson, R.
dc.contributor.authorShete, P.B.
dc.contributor.authorHandley, M.A.
dc.contributor.authorAckerman, S.
dc.contributor.authorJoloba, M.
dc.contributor.authorMoore, D.A.J.
dc.contributor.authorDavis, J.L.
dc.contributor.authorDowdy, D.W.
dc.contributor.authorFielding, K.
dc.contributor.authorKatamba, A.
dc.date.accessioned2023-01-18T18:27:46Z
dc.date.available2023-01-18T18:27:46Z
dc.date.issued2021
dc.description.abstractEffective 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.)en_US
dc.identifier.citationCattamanchi, A., Reza, T. F., Nalugwa, T., Adams, K., Nantale, M., Oyuku, D., ... & Katamba, A. (2021). Multicomponent Strategy with Decentralized Molecular Testing for Tuberculosis. New England Journal of Medicine, 385(26), 2441-2450. DOI: 10.1056/NEJMoa2105470en_US
dc.identifier.urihttps://www.nejm.org/doi/full/10.1056/NEJMoa2105470
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7055
dc.language.isoenen_US
dc.publisherNew England Journal of Medicineen_US
dc.subjectMulticomponent Strategyen_US
dc.subjectMolecular Testingen_US
dc.subjectTuberculosisen_US
dc.titleMulticomponent Strategy with Decentralized Molecular Testing for Tuberculosisen_US
dc.typeArticleen_US
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