Implementation and Operational Research: Use of Symptom Screening and Sputum Microscopy Testing for Active Tuberculosis Case Detection Among HIV-Infected Patients in Real-World Clinical Practice in Uganda

Roy, Monika; Muyindike, Winnie; Vijayan, Tara; Kanyesigye, Michael; Bwana, Mwebesa; Wenger, Megan; Martin, Jeffrey N.; Geng, Elvin

doi:10.1097/qai.0000000000001067

Cited by 13 publications

(10 citation statements)

References 13 publications

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“…This is very low compared to the desired target of 100% and given the high burden of TB/HIV in Ghana. It is possible that this low investigation rates contributes to the high annual mortality due to TB in PLHIV [9]. Low sputum ordering in PLHIV with a positive TB screen test has been reported in a number of studies.…”

Section: Lack Of Integration Of Tb Services Into Hiv Care and Treatment Servicesmentioning

confidence: 98%

“…In Uganda, patients with WHO stage III or IV (indicator of more advanced disease) were more likely to have sputum order [14]. Men were more likely than women to be investigated by sputum [12,19]. It should be noted that those studies reported that men were more likely to have advanced disease (lower CD4 cells/µl) compared to women.…”

Section: Lack Of Integration Of Tb Services Into Hiv Care and Treatment Servicesmentioning

confidence: 99%

“…In a study in Uganda among HIV infected patients, only 13.2% of the patients with a positive TB screen test had a sputum order documented [8]. In another study conducted in Uganda, 54.9% of HIV infected patients with a positive TB symptom screen test were referred for sputum smear examination [9]. Ghana has a high TB/HIV burden, considered among the top 30 countries with a high TB/HIV burden [1].…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Sputum Ordering for Tuberculosis Diagnosis in People Living with HIV in the Greater Accra Region, Ghana

Kasozi

Govule

Katongole

et al. 2021

Preprint

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BackgroundTuberculosis (TB) remains a significant public health concern, and a leading cause of ill-health and death globally. More so, People living with HIV have been shown to carry an increased risk of developing TB with an estimated one-third of deaths in this population. The World Health Organization recommends systematic and routine screening of PLHIV for TB on every clinic visit and further testing using sputum for those with a positive TB screen test. Not all PLHIV with a positive TB screen test in Ghana are further tested for TB using sputum and the factors for this are not well understood. This study assessed factors associated with sputum ordering for TB diagnosis in PLHIV who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.MethodsMixed method study performed at three purposively selected hospitals providing HIV care and treatment services in the Greater Accra region. The study involved a cross sectional review of patients’ charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Quantitative data was analyzed using STATA version 15. Chi square test was used for bivariate analysis. Logistic regression was used for multivariate analysis. P≤ 0.05 was considered statistically significant. Inductive thematic analysis was used to determine emerging themes from the interviews. The major themes were represented with representative quotations.ResultsFour hundred (400) patient charts were reviewed of which 67.7% were female with median age of 39 (IQR 31-49). TB screening was recorded in 78% (95% CI 73.6, 82.0) of the patients of whom ninety-two (92) patients had a positive TB screen test. Only 53 (57.6%) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, patient general appearance described as abnormal (OR=3.05, p=0.036), having more than one TB symptom (OR=3.42, p=0.028) and presence of an alternative presumptive diagnosis (OR=0.34, p=0.023) were associated with having a sputum test ordered. High patient numbers, inability to produce sputum, unwillingness of the not so sick patients to provide sputum and the costs associated with chest X-ray were perceived as the challenges to further testing for TB.ConclusionTB screening in PLHIV is still lower than recommended and almost half of PLHIV with a positive TB screen test did not have a sputum test documented. Sputum testing was likely to be done in patients with an abnormal general appearance and more than one TB symptom and unlikely in those with an alternative presumptive diagnosis. High workload, costs of TB tests, lack of training for health workers and inability to produce sputum by patients were the barriers to sputum testing highlighted by the health workers.

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Section: Lack Of Integration Of Tb Services Into Hiv Care and Treatment Servicesmentioning

confidence: 98%

Section: Lack Of Integration Of Tb Services Into Hiv Care and Treatment Servicesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determinants of Sputum Ordering for Tuberculosis Diagnosis in People Living with HIV in the Greater Accra Region, Ghana

Kasozi

Govule

Katongole

et al. 2021

Preprint

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“…Likewise, data from adult TB (DR and MDR) cascades in India [52] and South Africa [53] revealed major gaps along multiple steps, including diagnosis, treatment initiation, and treatment/post-treatment follow up, all needing additional attention. Data examining the TB diagnostic cascade in HIV-positive adults in Uganda demonstrated a huge drop off between the positive TB screens and obtaining sputum for testing [54]. These early studies highlight major gaps in the adult TB care cascades and allow for targeted areas of improvement.…”

Section: Introductionmentioning

confidence: 95%

Quality matters: Redefining child TB care with an emphasis on quality

Amanullah

Bacha

Fernández

et al. 2019

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Children have been neglected in the fight against tuberculosis (TB) for decades. Despite being the number one infectious disease killer, TB does not feature on the child survival agendas partly due to absent and inaccurate data. Quality is a missing ingredient in TB care in children, yet high rates of unfavorable TB outcomes highlight its importance in this age group. Quality care is particularly important for TB affected children in the absence of a point of care sensitive and specific diagnostic test. Using the current models of child TB care, it will take another 200 years to end TB. Without focusing on the quality of child TB care, the ambitious country specific United Nations High Level Meeting for TB targets will carry minimal impact. High TB burden countries must also adopt Universal Health Care (UHC) and ensure that quality TB care is made free and equitable for all children, adolescents and their affected families. We advocate for the importance of evaluating the quality of child TB care, and provide a basic framework for quality in child TB with special attention given to creating differentiated service delivery models for children and families affected by TB.

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“…Whereas this recommendation was made for TB screening among PLHIV, only a small proportion of PLHIV with a positive TB symptom screen test are referred for sputum examination for TB detection, even in high-burden TB/HIV settings [13]. For example, only 13.2%, 8%, and 37.1% of HIV-infected patients with a positive TB screen test had a sputum order documented for gene expert examination or chest x-ray for further active TB detection in Uganda, Kenya and Tanzania, respectively [14][15][16]. In addition, only 54.9% of HIVinfected patients with a positive TB symptom screen test were referred for sputum smear examination in Uganda [14].…”

Section: Introductionmentioning

confidence: 99%

Determinants of sputum ordering for tuberculosis diagnosis in people living with HIV in the Greater Accra Region, Ghana

2022

HSI Journal

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Background: This study assessed factors associated with sputum ordering for tuberculosis (TB) diagnosis in people living with HIV (PLHIV) who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.Objective: This study assessed the factors associated with sputum ordering in PLHIV with a positive TB symptom screen test.Methods: A mixed-method cross-sectional study was undertaken at three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana. The study involved a review of 400 patients' charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Bivariate analysis using a Chi-square test and Logistic regression for multivariate analysis were used to establish factors associated with sputum ordering. Factors having a p ≤ 0.05 were considered significantly associated with sputum ordering. Inductive thematic analysis was used to explain the associated factors. Results:Of the 400 charts reviewed, 67.7% were female patients with a median age of 39 (IQR 31 ̶ 49). TB screening was recorded in 78% (n = 312/400, 95% CI: 73.6 ̶ 82.0) of the patients, of whom ninety-two (92) patients had a positive TB screen test. Only 57.6% (n = 53) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, the patient's general appearance was described as abnormal (OR = 3.05, p = 0.036), having more than one TB symptom (OR = 3.42, p = 0.028) and presence of an alternative presumptive diagnosis (OR = 0.34, p = 0.023) were associated with having a sputum test ordered. High patient numbers, the inability to produce sputum, the unwillingness of moderately sick patients to provide sputum and the cost associated with chest X-rays were perceived as the challenges to further testing for TB. Conclusion:Almost half of PLHIV with a positive TB screen test did not have a sputum test documented. This calls for instituting measures to address the barriers to TB screening among people living with HIV/AIDS for effective TB and HIV comorbidity management.

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Implementation and Operational Research: Use of Symptom Screening and Sputum Microscopy Testing for Active Tuberculosis Case Detection Among HIV-Infected Patients in Real-World Clinical Practice in Uganda

Cited by 13 publications

References 13 publications

Determinants of Sputum Ordering for Tuberculosis Diagnosis in People Living with HIV in the Greater Accra Region, Ghana

Determinants of Sputum Ordering for Tuberculosis Diagnosis in People Living with HIV in the Greater Accra Region, Ghana

Quality matters: Redefining child TB care with an emphasis on quality

Determinants of sputum ordering for tuberculosis diagnosis in people living with HIV in the Greater Accra Region, Ghana

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