Lessons learned during tuberculosis screening in public medical clinics in Francistown, Botswana [Notes from the field]

Bloss, Emily; Makombe, Robert; Kip, Esther; Smit, Mikaëla; Chirenda, Joconiah; Gammino, Victoria M.; Creek, Tracy; Oeltmann, John E.

doi:10.5588/ijtld.11.0736

Cited by 12 publications

(12 citation statements)

References 5 publications

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“…Patients who could not produce sputum were not recorded, leading to an underestimate of the yield of this strategy for detecting pulmonary and extra-pulmonary TB patients without cough. Furthermore, the reason for attending the clinic was not recorded; therefore, unlike other studies where a substantial proportion of patients were not planning to see the doctor for their cough, 14,25 we cannot comment on patient motivation in our general medical clinic setting. Some patients may have attended to be seen for TB symptoms.…”

Section: Discussionmentioning

confidence: 94%

“…Some reports have used all patients eligible for screening as the denominator, while others used patients who participated in screening, based on narrower criteria such as TB-related symptoms. 7,14–16 In our general medical clinic, using patients identified by a simple screen performed by a nurse cough officer as the denominator, the case detection rate and the NNS to find one smear-positive patient were respectively 8.5% and 12. This yield is similar to findings in clinics offering antiretroviral treatment in a recent meta-analysis, 7 and better than that found in another recent general medical clinic ICF initiative in Botswana.…”

Section: Discussionmentioning

confidence: 99%

“…This yield is similar to findings in clinics offering antiretroviral treatment in a recent meta-analysis, 7 and better than that found in another recent general medical clinic ICF initiative in Botswana. 14 The incomplete information from the referral TB laboratory suggests that the use of auramine and culture with DST not only reduced the NNS but provided the added benefit of identifying those with drug-resistant TB in the general medical clinic setting.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to the recent lower yield and more complex screening protocol described in a general medical clinic in Botswana, 14 the screening algorithm in our program used a junior nurse and a simple protocol inquiring about cough only. Patients were requested to submit sputum immediately and were not burdened with additional clinic visits.…”

Section: Discussionmentioning

confidence: 99%

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‘Cough officer’ nurses in a general medical clinic successfully detect drug-susceptible and -resistant tuberculosis

Shenoi

Brooks

Catterick³

et al. 2013

public health action

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Setting Intensive case finding (ICF) for tuberculosis (TB) is recommended by the World Health Organization among known human immunodeficiency virus (HIV) patients. However, ICF may also be appropriate in generalized patient populations. Objective To evaluate the yield of ICF in a general medical clinic in a high HIV prevalence setting. Methods A nurse designated as a ‘cough officer’ identified clinic attendees with cough of >2 weeks and collected sputum for evaluation at the hospital and provincial referral laboratories. We retrospectively evaluated the number and proportion of patients with microbiologically confirmed TB identified in 2007–2008. Results Among 56 207 clinic attendees, 1442 (2.6%) TB suspects were identified and 122 (8.5%) were sputum Ziehl-Neelsen (ZN) positive. Of 389 available results, 72 (18.5%) were auramine-positive and 99 (25.4%) were culture-positive; multidrug-resistant and extensively drug-resistant TB were identified in 16 (16.2%). The number needed to screen was 11.8 patients to identify one ZN-positive case and 3.9 to identify one culture-positive case. Conclusions A nurse-facilitated cough officer program successfully identified TB suspects and drug-susceptible and drug-resistant TB. Culture was more sensitive for TB screening and critical for identifying drug resistance. ICF is operationally feasible, and should be expanded to general medical clinics in high HIV and TB prevalence, resource-limited settings.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

‘Cough officer’ nurses in a general medical clinic successfully detect drug-susceptible and -resistant tuberculosis

Shenoi

Brooks

Catterick³

et al. 2013

public health action

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“…TB symptom screening at initial clinic visit was relatively complete (>90%) but a sputum test was not ordered for the vast majority of symptom screen positive patients (87%). Two studies among non-HIV populations, using alternate symptom screening strategies (cough > 2 weeks duration and an eight item checklist, respectively), similarly identified provider lack of ordering as the main gap in their diagnostic cascades [8, 9]. …”

Section: Discussionmentioning

confidence: 99%

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

Muyindike

Vijayan

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background The uptake of intensified active TB case finding among HIV-infected patients using symptom screening is not well understood. We evaluated the rate and completeness of each interim step in the TB “diagnostic cascade” to understand real-world barriers to active TB case detection. Methods We conducted a cohort analysis of new, ART-naïve, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012 – September 30, 2013). We used medical records to extract the date of completion of each step in the diagnostic cascade: symptom screen, order, collection, processing, and result. Factors associated with lack of sputum order were evaluated using multivariate Poisson regression and a chart review of 50 screen positive patients. Results Of 2613 patients, 2439 (93%) were screened for TB and 682(28%) screened positive. Only 90(13.2%) had a sputum order. Of this group, 83% completed the diagnostic cascade, 13% were diagnosed with TB, and 50% had a sputum result within 1 day of their visit. Sputum ordering was associated with WHO Stage 3 or 4 HIV disease and greater number of symptoms. The main identifiable reasons for lack of sputum order in chart review were treatment for presumed malaria (51%) or bacterial infection (43%). Conclusions The majority of newly enrolled HIV-infected patients who screened positive for suspected TB did not have a sputum order, and those who did were more likely to have more advanced HIV disease and symptoms. Further evaluation of provider behavior in the management of screen positive patients could improve active TB case detection rates.

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Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status

Hoog¹,

Viney

Biermann

et al. 2022

Cochrane Database of Systematic Reviews

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Background Systematic screening in high‐burden settings is recommended as a strategy for early detection of pulmonary tuberculosis disease, reducing mortality, morbidity and transmission, and improving equity in access to care. Questioning for symptoms and chest radiography (CXR) have historically been the most widely available tools to screen for tuberculosis disease. Their accuracy is important for the design of tuberculosis screening programmes and determines, in combination with the accuracy of confirmatory diagnostic tests, the yield of a screening programme and the burden on individuals and the health service. Objectives To assess the sensitivity and specificity of questioning for the presence of one or more tuberculosis symptoms or symptom combinations, CXR, and combinations of these as screening tools for detecting bacteriologically confirmed pulmonary tuberculosis disease in HIV‐negative adults and adults with unknown HIV status who are considered eligible for systematic screening for tuberculosis disease. Second, to investigate sources of heterogeneity, especially in relation to regional, epidemiological, and demographic characteristics of the study populations. Search methods We searched the MEDLINE, Embase, LILACS, and HTA (Health Technology Assessment) databases using pre‐specified search terms and consulted experts for unpublished reports, for the period 1992 to 2018. The search date was 10 December 2018. This search was repeated on 2 July 2021. Selection criteria Studies were eligible if participants were screened for tuberculosis disease using symptom questions, or abnormalities on CXR, or both, and were offered confirmatory testing with a reference standard. We included studies if diagnostic two‐by‐two tables could be generated for one or more index tests, even if not all participants were subjected to a microbacteriological reference standard. We excluded studies evaluating self‐reporting of symptoms. Data collection and analysis We categorized symptom and CXR index tests according to commonly used definitions. We assessed the methodological quality of included studies using the QUADAS‐2 instrument. We examined the forest plots and receiver operating characteristic plots visually for heterogeneity. We estimated summary sensitivities and specificities (and 95% confidence intervals (CI)) for each index test using bivariate random‐effects methods. We analyzed potential sources of heterogeneity in a hierarchical mixed‐model. Main results The electronic database search identified 9473 titles and abstracts. Through expert consultation, we identified 31 reports on national tuberculosis prevalence surveys as eligible (of which eight were already captured in the search of the electronic databases), and we identified 957 potentially relevant articles through reference checking. After removal of duplicates, we assessed 10,415 ti...

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Lessons learned during tuberculosis screening in public medical clinics in Francistown, Botswana [Notes from the field]

Cited by 12 publications

References 5 publications

‘Cough officer’ nurses in a general medical clinic successfully detect drug-susceptible and -resistant tuberculosis

‘Cough officer’ nurses in a general medical clinic successfully detect drug-susceptible and -resistant tuberculosis

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

Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status

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