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Patel MA, Durovni B, Salazar-Austin N, Cavalcante SC, Golub JE, Chaisson RE, Chaisson LH, Saraceni V. TB prevalence among pregnant women with HIV in Rio de Janeiro, Brazil. Int J Tuberc Lung Dis 2024; 28:259-261. [PMID: 38659145 DOI: 10.5588/ijtld.23.0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- M A Patel
- University of Illinois College of Medicine, Chicago, IL, USA;, Center for Global Health, University of Illinois at Chicago, Chicago, IL, USA
| | - B Durovni
- Municipal Health Secretariat, Rio de Janeiro, RJ, Brazil
| | - N Salazar-Austin
- Johns Hopkins University School of Medicine, Baltimore, MD, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - S C Cavalcante
- Municipal Health Secretariat, Rio de Janeiro, RJ, Brazil;, Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, MD, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA;, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - R E Chaisson
- Johns Hopkins University School of Medicine, Baltimore, MD, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA;, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - L H Chaisson
- Center for Global Health, University of Illinois at Chicago, Chicago, IL, USA;, Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - V Saraceni
- Municipal Health Secretariat, Rio de Janeiro, RJ, Brazil
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Pishgar M, Harford S, Theis J, Galanter W, Rodríguez-Fernández JM, Chaisson LH, Zhang Y, Trotter A, Kochendorfer KM, Boppana A, Darabi H. A process mining- deep learning approach to predict survival in a cohort of hospitalized COVID-19 patients. BMC Med Inform Decis Mak 2022; 22:194. [PMID: 35879715 PMCID: PMC9309593 DOI: 10.1186/s12911-022-01934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Various machine learning and artificial intelligence methods have been used to predict outcomes of hospitalized COVID-19 patients. However, process mining has not yet been used for COVID-19 prediction. We developed a process mining/deep learning approach to predict mortality among COVID-19 patients and updated the prediction in 6-h intervals during the first 72 h after hospital admission.
Methods The process mining/deep learning model produced temporal information related to the variables and incorporated demographic and clinical data to predict mortality. The mortality prediction was updated in 6-h intervals during the first 72 h after hospital admission. Moreover, the performance of the model was compared with published and self-developed traditional machine learning models that did not use time as a variable. The performance was compared using the Area Under the Receiver Operator Curve (AUROC), accuracy, sensitivity, and specificity. Results The proposed process mining/deep learning model outperformed the comparison models in almost all time intervals with a robust AUROC above 80% on a dataset that was imbalanced. Conclusions Our proposed process mining/deep learning model performed significantly better than commonly used machine learning approaches that ignore time information. Thus, time information should be incorporated in models to predict outcomes more accurately.
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Affiliation(s)
- M Pishgar
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA
| | - S Harford
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA
| | - J Theis
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA
| | - W Galanter
- Departments of Medicine and Pharmacy Systems, Outcomes and Policy, UIC, Chicago, USA
| | | | | | - Y Zhang
- University of Illinois Hospital (UIH), UIC, Chicago, USA
| | - A Trotter
- Department of Medicine, UIC, Chicago, USA
| | | | - A Boppana
- University of Illinois Hospital (UIH), UIC, Chicago, USA
| | - H Darabi
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA.
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Naufal F, Chaisson LH, Robsky KO, Delgado-Barroso P, Alvarez-Manzo HS, Miller CR, Shapiro AE, Golub JE. Number needed to screen for TB in clinical, structural or occupational risk groups. Int J Tuberc Lung Dis 2022; 26:500-508. [PMID: 35650693 DOI: 10.5588/ijtld.21.0749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: Screening for active TB using active case-finding (ACF) may reduce TB incidence, prevalence, and mortality; however, yield of ACF interventions varies substantially across populations. We systematically reviewed studies reporting on ACF to calculate the number needed to screen (NNS) for groups at high risk for TB.METHODS: We conducted a literature search for studies reporting ACF for adults published between November 2010 and February 2020. We determined active TB prevalence detected through various screening strategies and calculated crude NNS for - TB confirmed using culture or Xpert® MTB/RIF, and weighted mean NNS stratified by screening strategy, risk group, and country-level TB incidence.RESULTS: We screened 27,223 abstracts; 90 studies were included (41 in low/moderate and 49 in medium/high TB incidence settings). High-risk groups included inpatients, outpatients, people living with diabetes (PLWD), migrants, prison inmates, persons experiencing homelessness (PEH), healthcare workers, and miners. Screening strategies included symptom-based screening, chest X-ray and Xpert testing. NNS varied widely across and within incidence settings based on risk groups and screening methods. Screening tools with higher sensitivity (e.g., Xpert, CXR) were associated with lower NNS estimates.CONCLUSIONS: NNS for ACF strategies varies substantially between adult risk groups. Specific interventions should be tailored based on local epidemiology and costs.
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Affiliation(s)
- F Naufal
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - L H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - K O Robsky
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - P Delgado-Barroso
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - H S Alvarez-Manzo
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - C R Miller
- World Health Organization, Geneva, Switzerland
| | - A E Shapiro
- Departments of Global Health and Medicine, University of Washington, Seattle, WA
| | - J E Golub
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
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Chaisson LH, Naufal F, Delgado-Barroso P, Alvarez-Manzo HS, Robsky KO, Miller CR, Golub JE, Shapiro AE. A systematic review of the number needed to screen for active TB among people living with HIV. Int J Tuberc Lung Dis 2021; 25:427-435. [PMID: 34049604 DOI: 10.5588/ijtld.21.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: Systematic screening for active TB is recommended for all people living with HIV (PLWH); however, case detection remains poor globally. We investigated the yield of active case finding (ACF) by calculating the number needed to screen (NNS) to detect a case of active TB among PLWH.METHODS: We identified studies reporting ACF for TB among PLWH published from November 2010 to February 2020. We calculated crude NNS for Xpert- or culture-confirmed TB and weighted mean NNS stratified by screening approach, population/risk group, and country TB burden.RESULTS: Of the 27,221 abstracts screened, we identified 58 studies eligible for inclusion, including 5 in low/moderate TB incidence settings and 53 in medium/high incidence settings. Populations screened for TB included inpatients, outpatients not receiving antiretroviral therapy (ART), outpatients receiving ART, those with CD4 < 200 cells/µL, children aged ≤15 years, pregnant PLWH, and PLWH in prisons. Screening tools included symptom-based screening, chest X-ray, C-reactive protein levels, and Xpert. The weighted mean NNS varied across groups but was consistently low, ranging from 4 among inpatients in moderate/high TB burden settings to 137 among pregnant PLWH in moderate/high TB burden settings.CONCLUSIONS: ACF is a high yield intervention among PLWH. Approaches to screening should be tailored to local epidemiological and health-system contexts, and sensitive screening tools such as Xpert should be implemented where feasible.
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Affiliation(s)
- L H Chaisson
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - F Naufal
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P Delgado-Barroso
- Department of Medicine Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - H S Alvarez-Manzo
- Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - K O Robsky
- Department of Medicine Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - C R Miller
- World Health Organization, Geneva, Switzerland
| | - J E Golub
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA, Department of Medicine Epidemiology, Johns Hopkins University, Baltimore, MD, USA, Department of International Health, Johns Hopkins University, Baltimore, MD
| | - A E Shapiro
- Departments of Global Health and Medicine, University of Washington, Seattle, WA, USA
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Shete PB, Nalugwa T, Farr K, Ojok C, Nantale M, Howlett P, Haguma P, Ochom E, Mugabe F, Joloba M, Chaisson LH, Dowdy DW, Moore D, Davis JL, Katamba A, Cattamanchi A. Feasibility of a streamlined tuberculosis diagnosis and treatment initiation strategy. Int J Tuberc Lung Dis 2018. [PMID: 28633698 PMCID: PMC5479151 DOI: 10.5588/ijtld.16.0699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE: 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.
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Affiliation(s)
- P B Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - T Nalugwa
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - K Farr
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - C Ojok
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - M Nantale
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - P Howlett
- Faculty of Infectious and Tropical Diseases and TB Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - P Haguma
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - E Ochom
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - F Mugabe
- Uganda National Tuberculosis and Leprosy Control Programme, Kampala
| | - M Joloba
- School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - L H Chaisson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - D Moore
- Faculty of Infectious and Tropical Diseases and TB Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - J L Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - A Katamba
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
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Chaisson LH, Reber C, Phan H, Switz N, Nilsson LM, Myers F, Nhung NV, Luu L, Pham T, Vu C, Nguyen H, Nguyen A, Dinh T, Nahid P, Fletcher DA, Cattamanchi A. Evaluation of mobile digital light-emitting diode fluorescence microscopy in Hanoi, Viet Nam. Int J Tuberc Lung Dis 2016; 19:1068-72. [PMID: 26260826 DOI: 10.5588/ijtld.15.0018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
SETTING Hanoi Lung Hospital, Hanoi, Viet Nam. OBJECTIVE To compare the accuracy of CellScopeTB, a manually operated mobile digital fluorescence microscope, with conventional microscopy techniques. DESIGN Patients referred for sputum smear microscopy to the Hanoi Lung Hospital from May to September 2013 were included. Ziehl-Neelsen (ZN) smear microscopy, conventional light-emitting diode (LED) fluorescence microscopy (FM), CellScopeTB-based LED FM and Xpert(®) MTB/RIF were performed on sputum samples. The sensitivity and specificity of microscopy techniques were determined in reference to Xpert results, and differences were compared using McNemar's paired test of proportions. RESULTS Of 326 patients enrolled, 93 (28.5%) were Xpert-positive for TB. The sensitivity of ZN microscopy, conventional LED FM, and CellScopeTB-based LED FM was respectively 37.6% (95%CI 27.8-48.3), 41.9% (95%CI 31.8-52.6), and 35.5% (95%CI 25.8-46.1). The sensitivity of CellScopeTB was similar to that of conventional LED FM (difference -6.5%, 95%CI -18.2 to 5.3, P = 0.33) and ZN microscopy (difference -2.2%, 95%CI -9.2 to 4.9, P = 0.73). The specificity was >99% for all three techniques. DISCUSSION CellScopeTB performed similarly to conventional microscopy techniques in the hands of experienced TB microscopists. However, the sensitivity of all sputum microscopy techniques was low. Options enabled by digital microscopy, such as automated imaging with real-time computerized analysis, should be explored to increase sensitivity.
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Affiliation(s)
- L H Chaisson
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA
| | - C Reber
- Bioengineering Department, University of California Berkeley, Berkeley, USA
| | - H Phan
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA
| | - N Switz
- Bioengineering Department, University of California Berkeley, Berkeley, USA; Biophysics Graduate Group, University of California Berkeley, Berkeley, California, USA
| | - L M Nilsson
- Bioengineering Department, University of California Berkeley, Berkeley, USA
| | - F Myers
- Bioengineering Department, University of California Berkeley, Berkeley, USA
| | - N V Nhung
- National Lung Hospital, Ba Dinh, Hanoi
| | - L Luu
- Hanoi Health Services Department, Ba Dinh, Hanoi
| | - T Pham
- Hanoi Lung Hospital, Hai Ba Trung, Hanoi, Viet Nam
| | - C Vu
- Hanoi Lung Hospital, Hai Ba Trung, Hanoi, Viet Nam
| | - H Nguyen
- Hanoi Lung Hospital, Hai Ba Trung, Hanoi, Viet Nam
| | - A Nguyen
- Hanoi Lung Hospital, Hai Ba Trung, Hanoi, Viet Nam
| | - T Dinh
- Hanoi Lung Hospital, Hai Ba Trung, Hanoi, Viet Nam
| | - P Nahid
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA; Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - D A Fletcher
- Biophysics Graduate Group, University of California Berkeley, Berkeley, California, USA
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, USA; Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
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Semitala FC, Chaisson LH, den Boon S, Walter N, Cattamanchi A, Awor M, Katende J, Huang L, Joloba M, Albert H, Kamya MR, Davis JL. Impact of mycobacterial culture among HIV-infected adults with presumed TB in Uganda: a prospective cohort study. Public Health Action 2015; 5:106-11. [PMID: 26400379 PMCID: PMC4487479 DOI: 10.5588/pha.14.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/16/2014] [Accepted: 02/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation of new tuberculosis (TB) diagnostic strategies in resource-constrained settings is challenging. We measured the impact of solid and liquid mycobacterial cultures on treatment practices for patients undergoing TB evaluation in Kampala, Uganda. METHODS We enrolled consecutive smear-negative, human immunodeficiency virus positive adults with cough of ⩾2 weeks from September 2009 to April 2010. Laboratory technicians performed mycobacterial cultures on solid and liquid media. We compared empiric treatment decisions with solid and liquid culture in terms of diagnostic yield and time to results, and assessed impact on patient management. RESULTS Of 200 patients enrolled, 26 (13%) had culture-confirmed TB: 22 (85%) on solid culture alone, 2 (8%) on liquid culture alone, and 2 (8%) on both solid and liquid culture. Thirty-four patients received empiric anti-tuberculosis treatment, but only 10 (29%) were culture-positive. Median time to a positive result on solid culture was 92 days (interquartile range [IQR] 69-148) compared to 106 days (IQR 66-157) for liquid culture. No patients initiated treatment following a positive result on liquid culture. CONCLUSION The introduction of mycobacterial culture did not influence care for patients undergoing evaluation for TB in Kampala, Uganda. Attention to contextual factors surrounding implementation is needed to ensure the effective introduction of new testing strategies in low-income countries.
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Affiliation(s)
- F. C. Semitala
- Department of Medicine, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - L. H. Chaisson
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - S. den Boon
- Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda
| | - N. Walter
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, Colorado, USA
| | - A. Cattamanchi
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
- Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - M. Awor
- Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda
| | - J. Katende
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - L. Huang
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - M. Joloba
- Department of Microbiology, Makerere University School of Biomedical Sciences, Kampala, Uganda
| | - H. Albert
- Foundation for Innovative New Diagnostics, Kampala, Uganda
| | - M. R. Kamya
- Department of Medicine, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - J. L. Davis
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
- Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda
- Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
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