The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana

Åhsberg, Johanna; Bjerrum, Stephanie; Ganu, Vincent; Kwashie, Augustine; Commey, J. O. O.; Adusi-Poku, Yaw; Puplampu, Peter; Andersen, Åse Bengård; Kenu, Ernest; Lartey, Margaret; Johansen, Işık Somuncu

doi:10.1016/j.ijid.2022.12.044

Cited by 2 publications

(6 citation statements)

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“…The TBPOC study results have been published elsewhere, including the in-hospital TB diagnostic care cascade (18) and outcomes of the Determine LAM intervention study (15). In summary, we found that less than half of severely ill inpatients with HIV obtained a sputum Xpert for assessment of TB during admission.…”

Section: Quantitative Resultsmentioning

confidence: 57%

“…included the collection of qualitative data from FGDs and IDIs to provide an in-depth understanding of the user perspectives and the context for Determine LAM uptake and use. Data integration of the TBPOC study (15,18), HCW survey, and the FGD and IDI occurred at the methods level and the analysis and interpretation level (Figure 2; Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…The study sites and the routine TB diagnostic care cascade are described previously (15,18). Sites include Lekma Hospital (LH), Tema General Hospital (TGH), and Korle Bu Teaching Hospital The mixed methods study nested into the stepped wedge cluster-randomized trial implementing the Determine LAM test at three hospitals in Ghana.…”

Section: Study Sites and Context For Determine Lam Test Implementationmentioning

confidence: 99%

“…First, we (J.Å., B.P.T., and S.B.) developed a code scheme based on the research question, the topic guides, key preliminary findings from the TBPOC study (15,18) and the HCW survey, and key findings from published material in the field (9)(10)(11). Additionally, we included a few broad codes, which are as follows: What dilemmas do HCWs/patients experience?…”

Section: Qualitative Analysismentioning

confidence: 99%

“…Integration at the methods level occurred when preliminary results from the TBPOC study (15,18) and the HCW survey contributed to building the qualitative topic guides and when the HCW survey was connected to the qualitative data sampling (Figure 2) (25). Integration at the analysis and interpretation level occurred through joint display analysis and in the discussion (25, 26).…”

Section: Integrationmentioning

confidence: 99%

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Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study

Åhsberg,

Tersbøl,

Puplampu

et al. 2024

Front. Public Health

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BackgroundThe urine Determine LAM test has the potential to identify tuberculosis (TB) and reduce early mortality among people living with HIV. However, implementation of the test in practice has been slow. We aimed to understand how a Determine LAM intervention was received and worked in a Ghanaian in-hospital context.Design/MethodsNested in a Determine LAM intervention study, we conducted a two-phase explanatory sequential mixed methods study at three hospitals in Ghana between January 2021 and January 2022. We performed a quantitative survey with 81 healthcare workers (HCWs), four qualitative focus-group discussions with 18 HCWs, and 15 in-depth HCW interviews. Integration was performed at the methods and analysis level. Descriptive analysis, qualitative directed content analysis, and mixed methods joint display were used.ResultsThe gap in access to TB testing when relying on sputum GeneXpert MTB/Rif alone was explained by difficulties in obtaining sputum samples and an in-hospital system that relies on relatives. The Determine LAM test procedure was experienced as easy, and most eligible patients received a test. HCWs expressed that immediate access to Determine LAM tests empowered them in rapid diagnosis. The HCW survey confirmed that bedside was the most common place for Determine LAM testing, but qualitative interviews with nurses revealed concerns about patient confidentiality when performing and disclosing the test results at the bedside. Less than half of Determine LAM-positive patients were initiated on TB treatment, and qualitative data identified a weak link in the communication of the Determine LAM results. Moreover, HCWs were reluctant to initiate Determine LAM-positive patients on TB treatment due to test specificity concerns. The Determine LAM intervention did not have an impact on the time to TB treatment as expected, but patients were, in general, initiated on TB treatment rapidly. We further identified a barrier to accessing TB treatment during weekends and that treatment by tradition is administrated early in the morning.ConclusionThe Determine LAM testing was feasible and empowered HCWs in the management of HIV-associated TB. Important gaps in routine care and Determine LAM-enhanced TB care were often explained by the context. These findings may inform in-hospital quality improvement work and scale-up of Determine LAM in similar settings.

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Section: Quantitative Resultsmentioning

confidence: 57%

Section: Methodsmentioning

confidence: 99%

Section: Study Sites and Context For Determine Lam Test Implementationmentioning

confidence: 99%

Section: Qualitative Analysismentioning

confidence: 99%

Section: Integrationmentioning

confidence: 99%

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Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study

Åhsberg,

Tersbøl,

Puplampu

et al. 2024

Front. Public Health

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Point-of-Care Urine Lipoarabinomannan Testing to Guide Tuberculosis Treatment Among Severely Ill Inpatients With Human Immunodeficiency Virus in Real-World Practice: A Multicenter Stepped Wedge Cluster-Randomized Trial From Ghana

Åhsberg

Puplampu

Kwashie³

et al. 2023

Clinical Infectious Diseases

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Background The lateral flow urine lipoarabinomannan assay, Determine TB-LAM (Determine LAM), offers the potential for timely tuberculosis (TB) treatment among people living with HIV (PWH). Methods In this cluster-randomized trial, Determine LAM was made available with staff training with performance feedback at three hospitals in Ghana. Newly admitted PWH with a positive WHO four-symptom screen for TB, severe illness, or advanced HIV were enrolled. The primary outcome was days from enrollment to TB treatment initiation. We also reported the proportion of patients with a TB diagnosis, initiating TB treatment, all-cause mortality, and Determine LAM uptake at 8 weeks. Results We enrolled 422 patients including 174 (41.2%) in the intervention group. The median CD4 count was 87 cells/mm3 (IQR 25-205) and 138 patients (32.7%) were on antiretroviral therapy. More patients were diagnosed with TB in the intervention group compared with the control group, 59 (34.1%; 95%CI27.1-41.7) vs 46 (18.7%; 95%CI14.0-24.1), p <0.001. Time to TB treatment remained constant at a median of 3 days (IQR 1-8), but patients were more likely to initiate TB treatment, aHR 2.19 (95%CI1.60-3.00) during the intervention. Of patients with a Determine LAM test available, 41 (25.3%) tested positive. Of those, 19 (46.3%) initiated TB treatment. Overall, 118 patients had died (28.2%; 95%CI24.0-33.0) at 8 weeks follow-up. Conclusions The Determine LAM intervention in real-world practice increased TB diagnosis and the probability of TB treatment but did not reduce time to treatment initiation. Despite high uptake, only half of the LAM-positive patients initiated TB treatment.

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The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana

Cited by 2 publications

References 44 publications

Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study

Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study

Point-of-Care Urine Lipoarabinomannan Testing to Guide Tuberculosis Treatment Among Severely Ill Inpatients With Human Immunodeficiency Virus in Real-World Practice: A Multicenter Stepped Wedge Cluster-Randomized Trial From Ghana

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