Performance of the new WHO diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV prevalent settings: A multisite study in Uganda

Stella-Talisuna Alamo, Setor Kunutsor, John Walley, Janine Thoulass, Morgan Evans, Simon Muchuro, Ahmed Matovu, Elly Katabira

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03).

Methods A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum community-based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV-infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints.

Results WHO07 reduced the time to diagnosis of smear-negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear-negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 vs. 28.5 days, P = 0.003). Diagnostic specificity and sensitivity [95% confidence intervals (CIs)] for smear-negative PTB were higher at the rural hospital compared with the urban ASO: [98% (93–100%) vs. 86% (77–92%), P = 0.001] and [95% (72–100%) vs. 90% (54–99%), P > 0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow-up appointments and poor adherence by healthcare workers to algorithms.

Conclusion At both sites, WHO07 expedited diagnosis of smear-negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource-limited settings.
Original languageEnglish
Pages (from-to)884-895
Number of pages12
JournalTropical Medicine and International Health
Volume17
Issue number7
Early online date11 May 2012
DOIs
Publication statusPublished - Jul 2012

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Uganda
Pulmonary Tuberculosis
Acquired Immunodeficiency Syndrome
HIV
Rural Hospitals
Organizations
Guidelines
Poverty Areas
District Hospitals
Appointments and Schedules
Tuberculosis
Confidence Intervals
Delivery of Health Care
Sensitivity and Specificity
Research

Keywords

  • pulmonary tuberculosis
  • diagnostic
  • smear negative
  • HIV prevalent
  • resource limited

Cite this

Performance of the new WHO diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV prevalent settings : A multisite study in Uganda. / Alamo, Stella-Talisuna; Kunutsor, Setor; Walley, John; Thoulass, Janine; Evans, Morgan; Muchuro, Simon; Matovu, Ahmed; Katabira, Elly.

In: Tropical Medicine and International Health, Vol. 17, No. 7, 07.2012, p. 884-895.

Research output: Contribution to journalArticle

Alamo, Stella-Talisuna ; Kunutsor, Setor ; Walley, John ; Thoulass, Janine ; Evans, Morgan ; Muchuro, Simon ; Matovu, Ahmed ; Katabira, Elly. / Performance of the new WHO diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV prevalent settings : A multisite study in Uganda. In: Tropical Medicine and International Health. 2012 ; Vol. 17, No. 7. pp. 884-895.
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abstract = "Objective To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03). Methods A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum community-based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV-infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints. Results WHO07 reduced the time to diagnosis of smear-negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear-negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 vs. 28.5 days, P = 0.003). Diagnostic specificity and sensitivity [95{\%} confidence intervals (CIs)] for smear-negative PTB were higher at the rural hospital compared with the urban ASO: [98{\%} (93–100{\%}) vs. 86{\%} (77–92{\%}), P = 0.001] and [95{\%} (72–100{\%}) vs. 90{\%} (54–99{\%}), P > 0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow-up appointments and poor adherence by healthcare workers to algorithms. Conclusion At both sites, WHO07 expedited diagnosis of smear-negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource-limited settings.",
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AU - Alamo, Stella-Talisuna

AU - Kunutsor, Setor

AU - Walley, John

AU - Thoulass, Janine

AU - Evans, Morgan

AU - Muchuro, Simon

AU - Matovu, Ahmed

AU - Katabira, Elly

N1 - © 2012 Blackwell Publishing Ltd.

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N2 - Objective To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03). Methods A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum community-based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV-infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints. Results WHO07 reduced the time to diagnosis of smear-negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear-negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 vs. 28.5 days, P = 0.003). Diagnostic specificity and sensitivity [95% confidence intervals (CIs)] for smear-negative PTB were higher at the rural hospital compared with the urban ASO: [98% (93–100%) vs. 86% (77–92%), P = 0.001] and [95% (72–100%) vs. 90% (54–99%), P > 0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow-up appointments and poor adherence by healthcare workers to algorithms. Conclusion At both sites, WHO07 expedited diagnosis of smear-negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource-limited settings.

AB - Objective To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03). Methods A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum community-based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV-infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints. Results WHO07 reduced the time to diagnosis of smear-negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear-negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 vs. 28.5 days, P = 0.003). Diagnostic specificity and sensitivity [95% confidence intervals (CIs)] for smear-negative PTB were higher at the rural hospital compared with the urban ASO: [98% (93–100%) vs. 86% (77–92%), P = 0.001] and [95% (72–100%) vs. 90% (54–99%), P > 0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow-up appointments and poor adherence by healthcare workers to algorithms. Conclusion At both sites, WHO07 expedited diagnosis of smear-negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource-limited settings.

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KW - diagnostic

KW - smear negative

KW - HIV prevalent

KW - resource limited

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