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Divala TH, Lewis J, Bulterys MA, Lutje V, Corbett EL, Schumacher SG, MacPherson P. Missed opportunities for diagnosis and treatment in patients with TB symptoms: a systematic review. Public Health Action 2022; 12:10-17. [PMID: 35317535 PMCID: PMC8908873 DOI: 10.5588/pha.21.0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The identification of patients with symptoms is the foundation of facility-based TB screening and diagnosis, but underdiagnosis is common. We conducted this systematic review with the hypothesis that underdiagnosis is largely secondary to patient drop out along the diagnostic and care pathway. METHODS We searched (up to 22 January 2019) MEDLINE, Embase, and Cinahl for studies investigating patient pathway to TB diagnosis and care at health facilities. We used Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias. We reported proportions of patients with symptoms at each stage of the pathway from symptom screening to treatment initiation. RESULTS After screening 3,558 abstracts, we identified 16 eligible studies. None provided data addressing the full cascade of care from clinical presentation to treatment initiation in the same patient population. Symptom screening, the critical entry point for diagnosis of TB, was not done for 33-96% of participants with symptoms in the three studies that reported this outcome. The proportion of attendees with symptoms offered a diagnostic investigation (data available for 15 studies) was very low with a study level median of 38% (IQR 14-44, range 4-84). CONCLUSIONS Inefficiencies of the TB symptom screen-based patient pathway are a major contributor to underdiagnosis of TB, reflecting inconsistent implementation of guidelines to ask all patients attending health facilities about respiratory symptoms and to offer diagnostic tests to all patients promptly once TB symptoms are identified. Better screening tools and interventions to improve the efficiency of TB screening and diagnosis pathways in health facilities are urgently needed.
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Affiliation(s)
- T H Divala
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, UK
| | - J Lewis
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M A Bulterys
- Foundation for New Innovative Diagnostics, Geneva, Switzerland
- Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - V Lutje
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - E L Corbett
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, UK
- Foundation for New Innovative Diagnostics, Geneva, Switzerland
| | - S G Schumacher
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - P MacPherson
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- Liverpool School of Tropical Medicine, Liverpool, UK
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Garfein RS, Liu L, Cuevas-Mota J, Collins K, Catanzaro DG, Muñoz F, Moser K, Chuck C, Higashi J, Bulterys MA, Raab F, Rios P. Evaluation of recorded video-observed therapy for anti-tuberculosis treatment. Int J Tuberc Lung Dis 2021; 24:520-525. [PMID: 32398202 DOI: 10.5588/ijtld.19.0456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Asynchronous video directly observed therapy (VDOT) may reduce tuberculosis (TB) program costs and the burden on patients. We compared VDOT performance across three cities in the United States, each of which have TB incidence rates above the national average.METHODS: Patients aged ≥18 years who are currently receiving directly observed anti-TB treatment were invited to use VDOT for monitoring treatment. Pre- and post-treatment interviews and medical records were used to assess site differences in treatment adherence and patient characteristics and perceptions.RESULTS: Participants were enrolled in New York City, NY (n = 48), San Diego, CA (n = 52) and San Francisco, CA, USA (n = 49). Overall, the mean age was 41 years (range 18-87); 59% were male; most were Asian (45%) or Hispanic/Latino (30%); and 77% were foreign-born. The median fraction of expected doses observed (FEDO) was 88% (IQR 76-96). At follow-up, 97% thought VDOT was "very or somewhat easy to use" and 95% would recommend VDOT to other TB patients. Age, race/ethnicity, annual income, and country of birth differed by city (P < 0.05), but FEDO and VDOT perceptions did not.CONCLUSIONS: TB programs in three large US cities observed a high FEDO using VDOT while minimizing staff time and travel. Similar findings across sites support VDOT adoption by other large, urban TB programs.
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Affiliation(s)
- R S Garfein
- Division of Epidemiology, School of Medicine, University of California, San Diego, CA
| | - L Liu
- Division of Biostatistics and Bioinformatics, School of Medicine, University of California, San Diego, CA
| | - J Cuevas-Mota
- Division of Epidemiology, School of Medicine, University of California, San Diego, CA
| | - K Collins
- Division of Epidemiology, School of Medicine, University of California, San Diego, CA
| | - D G Catanzaro
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR
| | - F Muñoz
- Division of Epidemiology, School of Medicine, University of California, San Diego, CA
| | - K Moser
- San Diego County Health and Human Services Agency, San Diego, CA
| | - C Chuck
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - J Higashi
- San Francisco Department of Public Health, San Francisco, CA
| | - M A Bulterys
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - F Raab
- Qualcomm Institute, Calit2, San Diego Division, University of California, San Diego, CA, USA
| | - P Rios
- Qualcomm Institute, Calit2, San Diego Division, University of California, San Diego, CA, USA
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Armenta RF, Collins KM, Strathdee SA, Bulterys MA, Munoz F, Cuevas-Mota J, Chiles P, Garfein RS. Mycobacterium tuberculosis infection among persons who inject drugs in San Diego, California. Int J Tuberc Lung Dis 2018; 21:425-431. [PMID: 28284258 DOI: 10.5588/ijtld.16.0434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons who inject drugs (PWID) might be at increased risk for Mycobacterium tuberculosis infection and reactivation of latent tuberculous infection (LTBI) due to their injection drug use. OBJECTIVES To determine prevalence and correlates of M. tuberculosis infection among PWID in San Diego, California, USA. METHODS PWID aged 18 years underwent standardized interviews and serologic testing using an interferon-gamma release assay (IGRA) for LTBI and rapid point-of-care assays for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections. Independent correlates of M. tuberculosis infection were identified using multivariable log-binomial regression. RESULTS A total of 500 participants met the eligibility criteria. The mean age was 43.2 years (standard deviation 11.6); most subjects were White (52%) or Hispanic (30.8%), and male (75%). Overall, 86.7% reported having ever traveled to Mexico. Prevalence of M. tuberculosis infection was 23.6%; 0.8% were co-infected with HIV and 81.7% were co-infected with HCV. Almost all participants (95%) had been previously tested for M. tuberculosis; 7.6% had been previously told they were infected. M. tuberculosis infection was independently associated with being Hispanic, having longer injection histories, testing HCV-positive, and correctly reporting that people with 'sleeping' TB cannot infect others. CONCLUSIONS Strategies are needed to increase awareness about and treatment for M. tuberculosis infection among PWID in the US/Mexico border region.
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Affiliation(s)
- R F Armenta
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, San Diego
| | - K M Collins
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - S A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - M A Bulterys
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - F Munoz
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - J Cuevas-Mota
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - P Chiles
- Division of Pulmonology, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - R S Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
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