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Maja TF, Maposa D. An Investigation of Risk Factors Associated with Tuberculosis Transmission in South Africa Using Logistic Regression Model. Infect Dis Rep 2022; 14:609-620. [PMID: 36005268 PMCID: PMC9408379 DOI: 10.3390/idr14040066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background: South Africa has a high burden of tuberculosis (TB) disease and is currently not meeting the national and international reduction outcome targets. The TB prevalence rate of South Africa in 2015 was estimated at approximately 690 per 100,000 population per year, with an incidence rate of about 834 per 100,000 population. This study examines risk factors associated with development of TB in South Africa. Materials and Methods: This study utilised readily available open access secondary data of 2019 South African Health and Demographic Survey from Statistics South Africa (StatsSA) website, which was collected from self-reported information relating to TB in the household questionnaire. The factors analysed were of demographic, socio-economic and health nature. Bivariate and binary logistics analyses were carried out from which appropriate inferences were drawn on the association of TB with demographic, socio-economic and health factors. Results: In multivariate analysis the study revealed that age, personal weight, smoke, alcohol, asthma, province of residence, race and usually coughing were significantly associated with an increased risk of having TB. Conclusions and Recommendations: The results strongly suggest that young and older people coming from black and coloured ethic groups, who are asthmatic and cough frequently, and/or smoking and consuming alcohol are at high risk of developing TB. In addition, those who are overweight appear to have an increased risk of TB transmission, with the Western Cape, Eastern Cape, Northern Cape, Free State, North West and Gauteng being the hardest hit provinces. Hence, the study recommends that these factors must be taken into account in the planning and development of TB policies in order to work successfully towards the achievement of sustainable development goal of reducing TB by 80% before 2030.
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Spooner E, Reddy S, Ntoyanto S, Sakadavan Y, Reddy T, Mahomed S, Mlisana K, Dlamini M, Daniels B, Luthuli N, Ngomane N, Kiepiela P, Coutsoudis A. TB testing in HIV-positive patients prior to antiretroviral treatment. Int J Tuberc Lung Dis 2022; 26:224-231. [PMID: 35197162 PMCID: PMC8886959 DOI: 10.5588/ijtld.21.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: TB diagnosis in patients with HIV is challenging due to the lower sensitivities across tests. Molecular tests are preferred and the Xpert® MTB/RIF assay has limitations in lower-income settings. We evaluated the performance of loop-mediated isothermal amplification (LAMP) and the lipoarabinomannan (LAM) test in HIV-positive, ART-naïve clinic patients.METHODS: A total of 783 eligible patients were enrolled; three spot sputum samples of 646 patients were tested using TB-LAMP, Xpert, smear microscopy and culture, while 649 patients had TB-LAM testing. Sensitivity, specificity, and negative and positive predictive values were estimated with 95% confidence intervals.RESULTS: Sensitivities for smear microscopy, TB-LAMP and Xpert were respectively 50%, 63% and 74% compared to culture, with specificities of respectively 99.2%, 98.5% and 97.5%. An additional eight were positive on TB-LAM alone. Seventy TB patients (9%) were detected using standard-of-care testing, an additional 27 (3%) were detected using study testing. Treatment was initiated in 57/70 (81%) clinic patients, but only in 56% (57/97) of all those with positive TB tests; 4/8 multidrug-resistant samples were detected using Xpert.CONCLUSION: TB diagnostics continue to miss cases in this high-burden setting. TB-LAMP was more sensitive than smear microscopy, and if followed by culture and drug susceptibility testing as required, can diagnose TB in HIV-positive patients. TB-LAM is a useful add-in test and both tests at the point-of-care would maximise yield.
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Affiliation(s)
- E Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - S Reddy
- South African Medical Research Council, Durban, South Africa
| | - S Ntoyanto
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Y Sakadavan
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - S Mahomed
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa, Centre for AIDS Programme Research in South Africa, Durban, South Africa
| | - K Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - M Dlamini
- Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - B Daniels
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - N Luthuli
- EThekwini Health Unit, EThekwini Municipality, Durban, South Africa
| | - N Ngomane
- Occupational Health, Durban, South Africa
| | - P Kiepiela
- South African Medical Research Council, Durban, South Africa
| | - A Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Mwogi T, Mercer T, Tran DN(T, Tonui R, Tylleskar T, Were MC. Therapeutic turnaround times for common laboratory tests in a tertiary hospital in Kenya. PLoS One 2020; 15:e0230858. [PMID: 32267844 PMCID: PMC7141613 DOI: 10.1371/journal.pone.0230858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
METHODS We evaluated therapeutic TAT for a tertiary hospital in Western Kenya, using a time-motion study focusing specifically on common hematology and biochemistry orders. The aim was to determine significant bottlenecks in diagnostic testing processes at the institution. RESULTS A total of 356 (155 hematology and 201 biochemistry) laboratory tests were fully tracked from the time of ordering to availability of results to care providers. The total therapeutic TAT for all tests was 21.5 ± 0.249 hours (95% CI). The therapeutic TAT for hematology was 20.3 ± 0.331 hours (95% CI) while that for biochemistry tests was 22.2 ± 0.346 hours (95% CI). Printing, sorting and dispatch of the printed results emerged as the most significant bottlenecks, accounting for up to 8 hours of delay (Hematology-8.3 ± 1.29 hours (95% CI), Biochemistry-8.5 ± 1.18 hours (95% CI)). Time of test orders affected TAT, with orders made early in the morning and those in the afternoon experiencing the most delays in TAT. CONCLUSION Significant inefficiencies exist at multiple steps in the turnaround times for routine laboratory tests at a large referral hospital within an LMIC setting. Multiple opportunities exist to improve TAT and streamline processes around diagnostic testing in this and other similar settings.
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Affiliation(s)
- Thomas Mwogi
- Centre for International Health, University of Bergen, Bergen, Norway
- Directorate of Medicine, Moi Teaching and Referral Hospital, Eldoret, Uasin Gishu, Kenya
- Institute of Biomedical Informatics, Moi University, Eldoret, Uasin Gishu, Kenya
| | - Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, Texas, United States of America
| | - Dan N. (Tina) Tran
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafeyette, IN, United States of America
| | - Ronald Tonui
- Department of Immunology, Moi University, Eldoret, Uasin Gishu, Kenya
- Laboratory Services Division, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Martin C. Were
- Department of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- Institute of Biomedical Informatics, Moi University, Eldoret, Uasin Gishu, Kenya
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Lessells RJ, Cooke GS, McGrath N, Nicol MP, Newell ML, Godfrey-Faussett P. Impact of Point-of-Care Xpert MTB/RIF on Tuberculosis Treatment Initiation. A Cluster-randomized Trial. Am J Respir Crit Care Med 2017; 196:901-910. [PMID: 28727491 PMCID: PMC5649979 DOI: 10.1164/rccm.201702-0278oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/20/2017] [Indexed: 02/01/2023] Open
Abstract
RATIONALE Point-of-care (POC) diagnostics have the potential to reduce pretreatment loss to follow-up and delays to initiation of appropriate tuberculosis (TB) treatment. OBJECTIVES To evaluate the effect of a POC diagnostic strategy on initiation of appropriate TB treatment. METHODS We conducted a cluster-randomized trial of adults with cough who were HIV positive and/or at high risk of drug-resistant TB. Two-week time blocks were randomized to two strategies: (1) Xpert MTB/RIF test (Cepheid, Sunnyvale, CA) performed at a district hospital laboratory or (2) POC Xpert MTB/RIF test performed at a primary health care clinic. All participants provided two sputum specimens: one for the Xpert test and the other for culture as a reference standard. The primary outcome was the proportion of participants with culture-positive pulmonary tuberculosis (PTB) initiated on appropriate TB treatment within 30 days. MEASUREMENTS AND MAIN RESULTS Between August 22, 2011, and March 1, 2013, 36 two-week blocks were randomized, and 1,297 individuals were enrolled (646 in the laboratory arm, 651 in the POC arm), 159 (12.4%) of whom had culture-positive PTB. The proportions of participants with culture-positive PTB initiated on appropriate TB treatment within 30 days were 76.5% in the laboratory arm and 79.5% in the POC arm (odds ratio, 1.13; 95% confidence interval, 0.51-2.53; P = 0.76; risk difference, 3.1%; 95% confidence interval, -16.2 to 10.1). The median time to initiation of appropriate treatment was 7 days (laboratory) versus 1 day (POC). CONCLUSIONS POC positioning of the Xpert test led to more rapid initiation of appropriate TB treatment. Achieving one-stop diagnosis and treatment for all people with TB will require simpler, more sensitive diagnostics and broader strengthening of health systems. Clinical trial registered with www.isrctn.com (ISRCTN 18642314) and www.sanctr.gov.za (DOH-27-0711-3568).
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Affiliation(s)
- Richard J. Lessells
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Graham S. Cooke
- Division of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Nuala McGrath
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- Academic Unit of Primary Care and Population Sciences
- Department of Social Statistics and Demography, and
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mark P. Nicol
- Division of Medical Microbiology and
- Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; and
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Marie-Louise Newell
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Peter Godfrey-Faussett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Engel N, Davids M, Blankvoort N, Dheda K, Pant Pai N, Pai M. Making HIV testing work at the point of care in South Africa: a qualitative study of diagnostic practices. BMC Health Serv Res 2017. [PMID: 28623923 PMCID: PMC5473989 DOI: 10.1186/s12913-017-2353-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Point of care testing promises to reduce delays in diagnosing and initiating treatment for infectious diseases such as Human Immuno-deficiency Virus (HIV). In South Africa, decentralized HIV testing with rapid tests offers important lessons for point of care testing programs. Yet, little is known about the strategies of providers and clients to make HIV testing successful in settings short of equipment, human resources and space. We aimed at examining these strategies. Methods This paper is based on a larger qualitative study of diagnostic practices across major diseases and actors in homes, clinics, communities, hospitals and laboratories in South Africa. We conducted 101 semi-structured interviews and 7 focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and manufacturers between September 2012 and June 2013 in Durban, Cape Town and Eastern Cape. The topics explored included diagnostic processes and challenges, understanding of diagnosis, and visions of ideal tests. For this paper, the data on HIV testing processes in clinics, communities and hospitals was used. Results Strategies to make HIV testing work at point of care involve overcoming constraints in equipment, spaces, human resources and workload and actively managing diagnostic processes. We grouped these strategies into subthemes: maintaining relationships, adapting testing guidelines and practices to stock-outs, to physical space, and to different clients, turning the test into a tool to reach another aim and turning the testing process into a tool to enhance adherence. These adaptive strategies are locally negotiated solutions, often ad-hoc, depending on personal commitment, relationships, human resources, physical space and referral systems. In the process, testing is redefined and repurposed. Not all of these repurposing acts are successful in ensuring a timely diagnosis. Some lead to disruptions, unnecessary testing or delays with at times unclear implications for quality of diagnosis. Conclusion Tests shape relationships, professional roles and practices of users at point of care. At the same time, testing processes are dynamic and test results and processes take on new meanings for clients and providers. These insights are crucial for understanding the contexts within which diagnostic devices and policies need to function. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2353-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Postbus 616, NL - 6200, MD, Maastricht, The Netherlands.
| | - Malika Davids
- Lung Infection and Division of pulmonology and UCT lung Institute Department of Medicine, University of Cape Town, Anzio Road, Cape Town, 7925, South Africa
| | - Nadine Blankvoort
- Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Postbus 616, NL - 6200, MD, Maastricht, The Netherlands
| | - Keertan Dheda
- Lung Infection and Division of pulmonology and UCT lung Institute Department of Medicine, University of Cape Town, Anzio Road, Cape Town, 7925, South Africa
| | - Nitika Pant Pai
- Division of Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Centre, V Building, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, H3A1A1, Canada
| | - Madhukar Pai
- McGill International TB Centre, Department of Epidemiology & Biostatistics, McGill University, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada
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Petrose LG, Fisher AM, Douglas GP, Terry MA, Muula A, Chawani MS, Limula H, Driessen J. Assessing Perceived Challenges to Laboratory Testing at a Malawian Referral Hospital. Am J Trop Med Hyg 2016; 94:1426-32. [PMID: 27022150 PMCID: PMC4889768 DOI: 10.4269/ajtmh.15-0867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/26/2016] [Indexed: 11/07/2022] Open
Abstract
Adequate laboratory infrastructure in sub-Saharan Africa is vital for tackling the burden of infectious diseases such as human immunodeficiency virus and acquired immune deficiency syndrome, malaria, and tuberculosis, yet laboratories are ill-integrated into the diagnostic and care delivery process in low-resource settings. Although much of the literature focuses on disease-specific challenges around laboratory testing, we sought to identify horizontal challenges to the laboratory testing process through interviews with clinicians involved in the diagnostic process. Based on 22 interviews with physicians, nurses, clinical officers, medical students, and laboratory technicians, technologists and supervisors, we identified 12 distinct challenges in the areas of staff, materials, workflow, and the blood bank. These challenges underscore the informational challenges that compound more visible resource shortages in the laboratory testing process, which lend themselves to horizontal strengthening efforts around the diagnostic process.
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Affiliation(s)
- Lia G Petrose
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arielle M Fisher
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gerald P Douglas
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Martha A Terry
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adamson Muula
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marlen S Chawani
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Henry Limula
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julia Driessen
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Baobab Health Trust, Lilongwe, Malawi; Department of Laboratory Testing, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
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Davids M, Dheda K, Pant Pai N, Cogill D, Pai M, Engel N. A Survey on Use of Rapid Tests and Tuberculosis Diagnostic Practices by Primary Health Care Providers in South Africa: Implications for the Development of New Point-of-Care Tests. PLoS One 2015; 10:e0141453. [PMID: 26509894 PMCID: PMC4624929 DOI: 10.1371/journal.pone.0141453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/08/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective infectious disease control requires early diagnosis and treatment initiation. Point-of-care testing offers rapid turn-around-times, facilitating same day clinical management decisions. To maximize the benefits of such POC testing programs, we need to understand how rapid tests are used in everyday clinical practice. METHODS In this cross-sectional survey study, 400 primary healthcare providers in two cities in South Africa were interviewed on their use of rapid tests in general, and tuberculosis diagnostic practices, between September 2012 and June 2013. Public healthcare facilities were selected using probability-sampling techniques and private healthcare providers were randomly selected from the Health Professional Council of South Africa list. To ascertain differences between the two healthcare sectors 2-sample z-tests were used to compare sample proportions. RESULTS The numbers of providers interviewed were equally distributed between the public (n = 200) and private sector (n = 200). The most frequently reported tests in the private sector include blood pressure (99.5%), glucose finger prick (89.5%) and urine dipstick (38.5%); and in the public sector were pregnancy (100%), urine dipstick (100%), blood pressure (100%), glucose finger prick (99%) and HIV rapid test (98%). The majority of TB testing occurs in the public sector, where significantly more providers prefer Xpert MTB/RIF assay, the designated clinical TB diagnostic tool by the national TB program, as compared to the private sector (87% versus 71%, p-value >0.0001). Challenges with regard to TB diagnosis included the long laboratory turn-around-time, difficulty in obtaining sputum samples and lost results. All providers indicated that a new POC test for TB should be rapid and cheap, have good sensitivity and specificity, ease of sample acquisition, detect drug-resistance and work in HIV-infected persons. CONCLUSION/SIGNIFICANCE The existing centralized laboratory services, poor quality assurance, and lack of staff capacity deter the use of more rapid tests at POC. Further research into the practices and choices of these providers is necessary to aid the development of new POC tests.
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Affiliation(s)
- Malika Davids
- Lung Infection and Immunity Unit, Division of pulmonology and UCT lung Institute, Department of Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of pulmonology and UCT lung Institute, Department of Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa
| | - Nitika Pant Pai
- Division of Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Centre, V Building, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, H3A1A1, Canada
| | - Dolphina Cogill
- Lung Infection and Immunity Unit, Division of pulmonology and UCT lung Institute, Department of Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa
| | - Madhukar Pai
- McGill International TB Centre, Department of Epidemiology & Biostatistics, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada
| | - Nora Engel
- Department of Health, Ethics & Society, Research School for Public Health and Primary Care, Maastricht University, Postbus 616, NL - 6200 MD, Maastricht, The Netherlands
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Driessen J, Limula H, Gadabu OJ, Gamadzi G, Chitandale E, Ben-Smith A, Alide N, Douglas GP. Informatics solutions for bridging the gap between clinical and laboratory services in a low-resource setting. Afr J Lab Med 2015; 4:1-7. [PMID: 38440308 PMCID: PMC10911650 DOI: 10.4102/ajlm.v4i1.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/13/2015] [Indexed: 03/06/2024] Open
Abstract
Background There has been little formal analysis of laboratory systems in resource-limited settings, despite widespread consensus around the importance of a strong laboratory infrastructure. Objectives This study details the informational challenges faced by the laboratory at Kamuzu Central Hospital, a tertiary health facility in Malawi; and proposes ways in which informatics can bolster the efficiency and role of low-resource laboratory systems. Methods We evaluated previously-collected data on three different aspects of laboratory use. A four-week quality audit of laboratory test orders quantified challenges associated with collecting viable specimens for testing. Data on tests run by the laboratory over a one-year period described the magnitude of the demand for laboratory services. Descriptive information about the laboratory workflow identified informational process breakdowns in the pre-analytical and post-analytical phases and was paired with a 24-hour sample of laboratory data on results reporting. Results The laboratory conducted 242 242 tests over a 12-month period. The four-week quality audit identified 54% of samples as untestable. Prohibitive paperwork errors were identified in 16% of samples. Laboratory service workflows indicated a potential process breakdown in sample transport and results reporting resulting from the lack of assignment of these tasks to any specific employee cadre. The study of result reporting time showed a mean of almost six hours, with significant variation. Conclusions This analysis identified challenges in each phase of laboratory testing. Informatics could improve the management of this information by streamlining test ordering and the communication of test orders to the laboratory and results back to the ordering physician.
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Affiliation(s)
- Julia Driessen
- Department of Health Policy and Management, University of
Pittsburgh, Pittsburgh, United States
| | - Henry Limula
- Kamuzu Central Hospital, Ministry of Health, Lilongwe,
Malawi
| | | | - Gervase Gamadzi
- Kamuzu Central Hospital, Ministry of Health, Lilongwe,
Malawi
| | | | - Anne Ben-Smith
- Department of Biomedical Informatics, University of
Pittsburgh, United States
| | - Noor Alide
- Kamuzu Central Hospital, Ministry of Health, Lilongwe,
Malawi
| | - Gerald P. Douglas
- Center for Health Informatics for the Underserved,
University of Pittsburgh, United States
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