Abstract
SUMMARYOBJECTIVE:To assess the feasibility of a streamlined strategy for improving tuberculosis (TB) diagnostic evaluation and treatment initiation among patients with presumed TB.DESIGN:Single-arm interventional pilot study at five primary care health centers of a streamlined, SIngle-saMPLE (SIMPLE) TB diagnostic evaluation strategy: 1) examination of two smear results from a single spot sputum specimen using light-emitting diode fluorescence microscopy, and 2) daily transportation of smear-negative sputum samples to Xpert® MTB/RIF testing sites.RESULTS:Of 1212 adults who underwent sputum testing for TB, 99.6% had two smears examined from the spot sputum specimen. Sputum was transported for Xpert testing within 1 clinic day for 83% (907/1091) of the smear-negative patients. Of 157 (13%) patients with bacteriologically positive TB, 116 (74%) were identified using sputum smear microscopy and 41 (26%) using Xpert testing of smear-negative samples. Anti-tuberculosis treatment was initiated in 142 (90%) patients with bacteriologically positive TB, with a median time to treatment of 1 day for smear-positive patients and 6 days for smear-negative, Xpert-positive patients.CONCLUSION:The SIMPLE TB strategy led to successful incorporation of Xpert testing and rapid treatment initiation in the majority of patients with bacteriologically confirmed TB in a resource-limited setting.
Highlights
PROMPT DIAGNOSIS AND TREATMENT of tuberculosis (TB) patients is essential for making progress towards TB elimination
Health centers were included in the pilot if they were 1) using standard sputum smear microscopy as the primary method of TB diagnosis; 2) participating in NTLP-sponsored external quality assurance (EQA) for sputum smear microscopy; and 3) affiliated with a district or regional hospital offering Xpert testing
We evaluated a streamlined TB diagnostic strategy that sought to reduce the burden of diagnostic evaluations for TB on patients and providers
Summary
PROMPT DIAGNOSIS AND TREATMENT of tuberculosis (TB) patients is essential for making progress towards TB elimination. 4.3 million of the estimated 10.4 million new cases in 2016 were not detected and reported to the World Health Organization (WHO).[1] There are three overarching explanations for this large gap: TB patients are not being notified to public health authorities, they are not seeking care, or they are not being diagnosed and treated even after seeking care. The last explanation represents a clear health system failure that is common in high-burden countries: a recent systematic review found that up
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