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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.-
dc.contributor.authorDowdy, D. W.-
dc.contributor.authorFielding, K.-
dc.contributor.authorKatamba, A.-
dc.identifier.citationNEW ENGLAND JOURNAL OF MEDICINE, Vol.385 No.26, pp.2441-2450-
dc.description.abstractBACKGROUND 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.-
dc.titleMulticomponent Strategy with Decentralized Molecular Testing for Tuberculosis-
dc.citation.journaltitleNEW ENGLAND JOURNAL OF MEDICINE-
dc.contributor.affiliatedAuthorSohn, H.-
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  • College of Medicine
  • Department of Human Systems Medicine
Research Area 결핵, 국제보건, 에이즈


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