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Multicomponent Strategy with Decentralized Molecular Testing for Tuberculosis
DC Field | Value | Language |
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dc.contributor.author | Cattamanchi, A. | - |
dc.contributor.author | Reza, T. F. | - |
dc.contributor.author | Nalugwa, T. | - |
dc.contributor.author | Adams, K. | - |
dc.contributor.author | Nantale, M. | - |
dc.contributor.author | Oyuku, D. | - |
dc.contributor.author | Nabwire, S. | - |
dc.contributor.author | Babirye, D. | - |
dc.contributor.author | Turyahabwe, S. | - |
dc.contributor.author | Tucker, A. | - |
dc.contributor.author | Sohn, H. | - |
dc.contributor.author | Ferguson, O. | - |
dc.contributor.author | Thompson, R. | - |
dc.contributor.author | Shete, P. B. | - |
dc.contributor.author | Handley, M. A. | - |
dc.contributor.author | Ackerman, S. | - |
dc.contributor.author | Joloba, M. | - |
dc.contributor.author | Moore, D. A. J. | - |
dc.contributor.author | Davis, J. | - |
dc.contributor.author | Dowdy, D. W. | - |
dc.contributor.author | Fielding, K. | - |
dc.contributor.author | Katamba, A. | - |
dc.date.accessioned | 2024-05-14T04:34:20Z | - |
dc.date.available | 2024-05-14T04:34:20Z | - |
dc.date.created | 2024-05-14 | - |
dc.date.issued | 2021-12 | - |
dc.identifier.citation | NEW ENGLAND JOURNAL OF MEDICINE, Vol.385 No.26, pp.2441-2450 | - |
dc.identifier.issn | 0028-4793 | - |
dc.identifier.uri | https://hdl.handle.net/10371/201746 | - |
dc.description.abstract | BACKGROUND 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.language | 영어 | - |
dc.publisher | MASSACHUSETTS MEDICAL SOC | - |
dc.title | Multicomponent Strategy with Decentralized Molecular Testing for Tuberculosis | - |
dc.type | Article | - |
dc.identifier.doi | 10.1056/NEJMoa2105470 | - |
dc.citation.journaltitle | NEW ENGLAND JOURNAL OF MEDICINE | - |
dc.identifier.wosid | 000732866100012 | - |
dc.identifier.scopusid | 2-s2.0-85122080440 | - |
dc.citation.endpage | 2450 | - |
dc.citation.number | 26 | - |
dc.citation.startpage | 2441 | - |
dc.citation.volume | 385 | - |
dc.description.isOpenAccess | Y | - |
dc.contributor.affiliatedAuthor | Sohn, H. | - |
dc.type.docType | Article | - |
dc.description.journalClass | 1 | - |
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