Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers

TB REACH Team

Research output: Contribution to journalArticle

Abstract

Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the public health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare facilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04% higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95% confidence interval [CI], 5.60-28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76% higher in the intervention than in the control facilities (adjusted OR [AOR], 7.59; 95% CI, 2.19-26.33). After adjusting for the factors above, as well as human immunodeficiency virus and TB retreatment status, the proportion of TB cases who completed treatment was 29.16% higher (AOR, 4.89; 95% CI, 2.24-10.67) and the proportion of TB cases who were lost to follow-up was 66.98% lower (AOR, 0.04; 95% CI, 0.01-0.09). When compared with baseline performance, the intervention facilities had a significantly higher proportion of presumptive TB cases with a sputum examination (64.70% vs 3.44%; OR, 23.95; 95% CI, 12.96-44.25), and these facilities started 56.25% more smearpositive TB cases on treatment during the project period (AOR, 15.36; 95% CI, 6.57-35.91). Conclusions. Optimizing the existing healthcare workforce through a bundled diagnostics and on-site training intervention for nonphysician healthcare workers will rapidly improve TB case detection and outcomes towards global targets.

Original languageEnglish (US)
Article numberofv030
JournalOpen Forum Infectious Diseases
Volume2
Issue number1
DOIs
StatePublished - 2015

Fingerprint

Tuberculosis
Confidence Intervals
Delivery of Health Care
Facility Regulation and Control
Odds Ratio
Sputum
Public Health
Health Priorities
Retreatment
Lost to Follow-Up
Fluorescence Microscopy
Outpatients
Therapeutics
Age Groups
HIV

Keywords

  • Fluorescence microscopy
  • Health systems strengthening
  • Passive case finding
  • Sub-Saharan Africa
  • Task shifting
  • Tuberculosis
  • Xpert

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

@article{3631c946911b4cec92508719b72436e4,
title = "Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers",
abstract = "Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the public health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare facilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04{\%} higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95{\%} confidence interval [CI], 5.60-28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76{\%} higher in the intervention than in the control facilities (adjusted OR [AOR], 7.59; 95{\%} CI, 2.19-26.33). After adjusting for the factors above, as well as human immunodeficiency virus and TB retreatment status, the proportion of TB cases who completed treatment was 29.16{\%} higher (AOR, 4.89; 95{\%} CI, 2.24-10.67) and the proportion of TB cases who were lost to follow-up was 66.98{\%} lower (AOR, 0.04; 95{\%} CI, 0.01-0.09). When compared with baseline performance, the intervention facilities had a significantly higher proportion of presumptive TB cases with a sputum examination (64.70{\%} vs 3.44{\%}; OR, 23.95; 95{\%} CI, 12.96-44.25), and these facilities started 56.25{\%} more smearpositive TB cases on treatment during the project period (AOR, 15.36; 95{\%} CI, 6.57-35.91). Conclusions. Optimizing the existing healthcare workforce through a bundled diagnostics and on-site training intervention for nonphysician healthcare workers will rapidly improve TB case detection and outcomes towards global targets.",
keywords = "Fluorescence microscopy, Health systems strengthening, Passive case finding, Sub-Saharan Africa, Task shifting, Tuberculosis, Xpert",
author = "{TB REACH Team} and Manabe, {Yukari C} and Stella Zawedde-Muyanja and Burnett, {Sarah M.} and Frank Mugabe and Sarah Naikoba and Alex Coutinho and Victor Afayo and Jackie Asiimwe and Moses Kairanya and Agnes Kiragga and David Kuteesa and Pallen Mugabe and Kenneth Musisi and Fred Sserubuga",
year = "2015",
doi = "10.1093/ofid/ofv030",
language = "English (US)",
volume = "2",
journal = "Open Forum Infectious Diseases",
issn = "2328-8957",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Rapid improvement in passive tuberculosis case detection and tuberculosis treatment outcomes after implementation of a bundled laboratory diagnostic and on-site training intervention targeting mid-level providers

AU - TB REACH Team

AU - Manabe, Yukari C

AU - Zawedde-Muyanja, Stella

AU - Burnett, Sarah M.

AU - Mugabe, Frank

AU - Naikoba, Sarah

AU - Coutinho, Alex

AU - Afayo, Victor

AU - Asiimwe, Jackie

AU - Kairanya, Moses

AU - Kiragga, Agnes

AU - Kuteesa, David

AU - Mugabe, Pallen

AU - Musisi, Kenneth

AU - Sserubuga, Fred

PY - 2015

Y1 - 2015

N2 - Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the public health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare facilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04% higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95% confidence interval [CI], 5.60-28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76% higher in the intervention than in the control facilities (adjusted OR [AOR], 7.59; 95% CI, 2.19-26.33). After adjusting for the factors above, as well as human immunodeficiency virus and TB retreatment status, the proportion of TB cases who completed treatment was 29.16% higher (AOR, 4.89; 95% CI, 2.24-10.67) and the proportion of TB cases who were lost to follow-up was 66.98% lower (AOR, 0.04; 95% CI, 0.01-0.09). When compared with baseline performance, the intervention facilities had a significantly higher proportion of presumptive TB cases with a sputum examination (64.70% vs 3.44%; OR, 23.95; 95% CI, 12.96-44.25), and these facilities started 56.25% more smearpositive TB cases on treatment during the project period (AOR, 15.36; 95% CI, 6.57-35.91). Conclusions. Optimizing the existing healthcare workforce through a bundled diagnostics and on-site training intervention for nonphysician healthcare workers will rapidly improve TB case detection and outcomes towards global targets.

AB - Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the public health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare facilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04% higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95% confidence interval [CI], 5.60-28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76% higher in the intervention than in the control facilities (adjusted OR [AOR], 7.59; 95% CI, 2.19-26.33). After adjusting for the factors above, as well as human immunodeficiency virus and TB retreatment status, the proportion of TB cases who completed treatment was 29.16% higher (AOR, 4.89; 95% CI, 2.24-10.67) and the proportion of TB cases who were lost to follow-up was 66.98% lower (AOR, 0.04; 95% CI, 0.01-0.09). When compared with baseline performance, the intervention facilities had a significantly higher proportion of presumptive TB cases with a sputum examination (64.70% vs 3.44%; OR, 23.95; 95% CI, 12.96-44.25), and these facilities started 56.25% more smearpositive TB cases on treatment during the project period (AOR, 15.36; 95% CI, 6.57-35.91). Conclusions. Optimizing the existing healthcare workforce through a bundled diagnostics and on-site training intervention for nonphysician healthcare workers will rapidly improve TB case detection and outcomes towards global targets.

KW - Fluorescence microscopy

KW - Health systems strengthening

KW - Passive case finding

KW - Sub-Saharan Africa

KW - Task shifting

KW - Tuberculosis

KW - Xpert

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U2 - 10.1093/ofid/ofv030

DO - 10.1093/ofid/ofv030

M3 - Article

C2 - 26034778

AN - SCOPUS:84978328514

VL - 2

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