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Ledesma JR, Ma J, Vongpradith A, Maddison ER, Novotney A, Biehl MH, LeGrand KE, Ross JM, Jahagirdar D, Bryazka D, Feldman R, Abolhassani H, Abosetugn AE, Abu-Gharbieh E, Adebayo OM, Adnani QES, Afzal S, Ahinkorah BO, Ahmad SA, Ahmadi S, Ahmed Rashid T, Ahmed Salih Y, Aklilu A, Akunna CJ, Al Hamad H, Alahdab F, Alemayehu Y, Alene KA, Ali BA, Ali L, Alipour V, Alizade H, Al-Raddadi RM, Alvis-Guzman N, Amini S, Amit AML, Anderson JA, Androudi S, Antonio CAT, Antony CM, Anwer R, Arabloo J, Arja A, Asemahagn MA, Atre SR, Azhar GS, B DB, Babar ZUD, Baig AA, Banach M, Barqawi HJ, Barra F, Barrow A, Basu S, Belgaumi UI, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharjee NV, Bhattacharyya K, Bijani A, Bikbov B, Boloor A, Briko NI, Buonsenso D, Burugina Nagaraja S, Butt ZA, Carter A, Carvalho F, Charan J, Chatterjee S, Chattu SK, Chattu VK, Christopher DJ, Chu DT, Claassens MM, Dadras O, Dagnew AB, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darwesh AM, Dhamnetiya D, Dianatinasab M, Diaz D, Doan LP, Eftekharzadeh S, Elhadi M, Emami A, Enany S, Faraon EJA, Farzadfar F, Fernandes E, Ferro Desideri L, Filip I, Fischer F, Foroutan M, Frank TD, Garcia-Basteiro AL, Garcia-Calavaro C, Garg T, Geberemariyam BS, Ghadiri K, Ghashghaee A, Golechha M, Goodridge A, Gupta B, Gupta S, Gupta VB, Gupta VK, Haider MR, Hamidi S, Hanif A, Haque S, Harapan H, Hargono A, Hasaballah AI, Hashi A, Hassan S, Hassankhani H, Hayat K, Hezam K, Holla R, Hosseinzadeh M, Hostiuc M, Househ M, Hussain R, Ibitoye SE, Ilic IM, Ilic MD, Irvani SSN, Ismail NE, Itumalla R, Jaafari J, Jacobsen KH, Jain V, Javanmardi F, Jayapal SK, Jayaram S, Jha RP, Jonas JB, Joseph N, Joukar F, Kabir Z, Kamath A, Kanchan T, Kandel H, Katoto PDMC, Kayode GA, Kendrick PJ, Kerbo AA, Khajuria H, Khalilov R, Khatab K, Khoja AT, Khubchandani J, Kim MS, Kim YJ, Kisa A, Kisa S, Kosen S, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kucuk Bicer B, Kumar A, Kumar GA, Kumar N, Kumar N, Kwarteng A, Lak HM, Lal DK, Landires I, Lasrado S, Lee SWH, Lee WC, Lin C, Liu X, Lopukhov PD, Lozano R, Machado DB, Madhava Kunjathur S, Madi D, Mahajan PB, Majeed A, Malik AA, Martins-Melo FR, Mehta S, Memish ZA, Mendoza W, Menezes RG, Merie HE, Mersha AG, Mesregah MK, Mestrovic T, Mheidly NM, Misra S, Mithra P, Moghadaszadeh M, Mohammadi M, Mohammadian-Hafshejani A, Mohammed S, Molokhia M, Moni MA, Montasir AA, Moore CE, Nagarajan AJ, Nair S, Nair S, Naqvi AA, Narasimha Swamy S, Nayak BP, Nazari J, Neupane Kandel S, Nguyen TH, Nixon MR, Nnaji CA, Ntsekhe M, Nuñez-Samudio V, Oancea B, Odukoya OO, Olagunju AT, Oren E, P A M, Parthasarathi R, Pashazadeh Kan F, Pattanshetty SM, Paudel R, Paul P, Pawar S, Pepito VCF, Perico N, Pirestani M, Polibin RV, Postma MJ, Pourshams A, Prashant A, Pribadi DRA, Radfar A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman M, Rahmani AM, Ranasinghe P, Rao CR, Rawaf DL, Rawaf S, Reitsma MB, Remuzzi G, Renzaho AMN, Reta MA, Rezaei N, Rezahosseini O, Rezai MS, Rezapour A, Roshandel G, Roshchin DO, Sabour S, Saif-Ur-Rahman KM, Salam N, Samadi Kafil H, Samaei M, Samy AM, Saroshe S, Sartorius B, Sathian B, Sawyer SM, Senthilkumaran S, Seylani A, Shafaat O, Shaikh MA, Sharafi K, Shetty RS, Shigematsu M, Shin JI, Silva JP, Singh JK, Sinha S, Skryabin VY, Skryabina AA, Spurlock EE, Sreeramareddy CT, Steiropoulos P, Sufiyan MB, Tabuchi T, Tadesse EG, Tamir Z, Tarkang EE, Tekalegn Y, Tesfay FH, Tessema B, Thapar R, Tleyjeh II, Tobe-Gai R, Tran BX, Tsegaye B, Tsegaye GW, Ullah A, Umeokonkwo CD, Valadan Tahbaz S, Vo B, Vu GT, Waheed Y, Walters MK, Whisnant JL, Woldekidan MA, Wubishet BL, Yahyazadeh Jabbari SH, Yazie TSY, Yeshaw Y, Yi S, Yiğit V, Yonemoto N, Yu C, Yunusa I, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zumla A, Mokdad AH, Salomon JA, Reiner Jr RC, Lim SS, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990-2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis 2022; 22:222-241. [PMID: 34563275 PMCID: PMC8799634 DOI: 10.1016/s1473-3099(21)00449-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. METHODS We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. FINDINGS Globally, in 2019, among HIV-negative individuals, there were 1·18 million (95% uncertainty interval 1·08-1·29) deaths due to tuberculosis and 8·50 million (7·45-9·73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1·15 million (1·01-1·32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1·01 million (0·82-1·23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1·5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4·27 (3·69-5·02), 6·17 (5·48-7·02), and 1·17 (1·07-1·28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2·23 (2·03-2·44) times greater among males than females, whereas the fraction due to unsafe sex was 1·06 (1·05-1·08) times greater among females than males. INTERPRETATION As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestones. FUNDING Bill & Melinda Gates Foundation.
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Armstrong-Hough M, Ggita J, Turimumahoro P, Meyer AJ, Ochom E, Dowdy D, Cattamanchi A, Katamba A, Davis JL. 'Something so hard': a mixed-methods study of home sputum collection for tuberculosis contact investigation in Uganda. Int J Tuberc Lung Dis 2019; 22:1152-1159. [PMID: 30236182 DOI: 10.5588/ijtld.18.0129] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Home sputum collection could facilitate prompt evaluation and diagnosis of tuberculosis (TB) among contacts of patients with active TB. We analyzed barriers to home-based collection as part of an enhanced intervention for household TB contact investigation in Kampala, Uganda. DESIGN We conducted a convergent mixed-methods study to describe the outcomes of home sputum collection in 91 contacts and examine their context through 19 nested contact interviews and two focus group discussions with lay health workers (LHWs). RESULTS LHWs collected sputum from 35 (39%) contacts. Contacts reporting cough were more likely to provide sputum than those with other symptoms or risk factors (53% vs. 15%, RR 3.6, 95%CI 1.5-2.8, P < 0.001). Males were more likely than females to provide sputum (54% vs. 32%, RR 1.7, 95%CI 1.0-2.8, P = 0.05). Contacts said support from the index patient and the convenience of the home visit facilitated collection. Missing containers and difficulty producing sputum spontaneously impeded collection. Women identified stigma as a barrier. LHWs emphasized difficulty in procuring sputum and discomfort pressing contacts to produce sputum. CONCLUSIONS Home sputum collection by LHWs entails different challenges from sputum collection in clinical settings. More research is needed to develop interventions to mitigate stigma and increase success of home-based collection.
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Affiliation(s)
- M Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - J Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A J Meyer
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Dowdy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda, Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - J L Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
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Hsiao A, Vogt V, Quentin W. Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa. PLoS One 2019; 14:e0220583. [PMID: 31433821 PMCID: PMC6703670 DOI: 10.1371/journal.pone.0220583] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/18/2019] [Indexed: 12/01/2022] Open
Abstract
Background Achieving Universal Health Coverage (UHC) by improving financial protection and effective service coverage is target 3.8 of the Sustainable Development Goals. Little is known, however, about the extent to which paying bribes within healthcare acts as a financial barrier to access and, thus, UHC. Methods Using survey data in adults from 32 sub-Saharan African countries in 2014–2015, we constructed a multilevel model to evaluate the relationship between paying bribes and reported difficulties of obtaining medical care. We controlled for individual-, region-, and country-level variables. Results Having paid bribes for medical care significantly increased the odds of reporting difficulties in obtaining care by 4.11 (CI: 3.70–4.57) compared to those who never paid bribes, and more than doubled for those who paid bribes often (OR = 9.52; 95% CI: 7.77–11.67). Respondents with higher levels of education and more lived poverty also had increased odds. Those who lived in rural areas or within walking distance to a health clinic had reduced odds of reporting difficulties. Sex, age, living in a capital region, healthcare expenditures per capita, and country Corruption Perception Index were not significant predictors. Conclusions We found that bribery in healthcare is a significant barrier to healthcare access, negatively affecting the potential of African countries to make progress toward UHC. Future increases in health expenditures—which are needed in many countries to achieve UHC—should be accompanied by greater efforts to fight corruption in order to avoid wasting money. Measuring and tracking health sector-specific corruption is critical for progress toward UHC.
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Affiliation(s)
- Amber Hsiao
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
- * E-mail:
| | - Verena Vogt
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
| | - Wilm Quentin
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
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Ayakaka I, Ackerman S, Ggita JM, Kajubi P, Dowdy D, Haberer JE, Fair E, Hopewell P, Handley MA, Cattamanchi A, Katamba A, Davis JL. Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda: a behavioral approach. Implement Sci 2017; 12:33. [PMID: 28274245 PMCID: PMC5343292 DOI: 10.1186/s13012-017-0561-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/21/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends routine household tuberculosis contact investigation in high-burden countries but adoption has been limited. We sought to identify barriers to and facilitators of TB contact investigation during its introduction in Kampala, Uganda. METHODS We collected cross-sectional qualitative data through focus group discussions and interviews with stakeholders, addressing three core activities of contact investigation: arranging household screening visits through index TB patients, visiting households to screen contacts and refer them to clinics, and evaluating at-risk contacts coming to clinics. We analyzed the data using a validated theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, and sought to identify targeted interventions using the related Behavior Change Wheel implementation framework. RESULTS We led seven focus-group discussions with 61 health-care workers, two with 21 lay health workers (LHWs), and one with four household contacts of newly diagnosed TB patients. We, in addition, performed 32 interviews with household contacts from 14 households of newly diagnosed TB patients. Commonly noted barriers included stigma, limited knowledge about TB among contacts, insufficient time and space in clinics for counselling, mistrust of health-center staff among index patients and contacts, and high travel costs for LHWs and contacts. The most important facilitators identified were the personalized and enabling services provided by LHWs. We identified education, persuasion, enablement, modeling of health-positive behaviors, incentivization, and restructuring of the service environment as relevant intervention functions with potential to alleviate barriers to and enhance facilitators of TB contact investigation. CONCLUSIONS The use of a behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and facilitators of TB contact investigation. The behavioral determinants identified here may be useful in tailoring interventions to improve implementation of contact investigation in Kampala and other similar urban settings.
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Affiliation(s)
- Irene Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sara Ackerman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA USA
| | - Joseph M. Ggita
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Phoebe Kajubi
- Child Health and Development Centre, School of Medicine; College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, and Harvard University Medical School, Boston, MA USA
| | - Elizabeth Fair
- Division of Pulmonary and Critical Care Medicine, and Curry International Tuberculosis Center, San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Philip Hopewell
- Division of Pulmonary and Critical Care Medicine, and Curry International Tuberculosis Center, San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Margaret A. Handley
- Department of Biostatistics and Epidemiology, School of Medicine, University of California, San Francisco, CA USA
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, and Curry International Tuberculosis Center, San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Achilles Katamba
- Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - J. Lucian Davis
- Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, CT USA
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Khan MS, Khine TM, Hutchison C, Coker RJ, Hane KM, Innes AL, Aung S. Are current case-finding methods under-diagnosing tuberculosis among women in Myanmar? An analysis of operational data from Yangon and the nationwide prevalence survey. BMC Infect Dis 2016; 16:110. [PMID: 26940910 PMCID: PMC4778364 DOI: 10.1186/s12879-016-1429-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 11/03/2015] [Accepted: 02/10/2016] [Indexed: 12/04/2022] Open
Abstract
Background Although there is a large increase in investment for tuberculosis control in Myanmar, there are few operational analyses to inform policies. Only 34 % of nationally reported cases are from women. In this study, we investigate sex differences in tuberculosis diagnoses in Myanmar in order to identify potential health systems barriers that may be driving lower tuberculosis case finding among women. Methods From October 2014 to March 2015, we systematically collected data on all new adult smear positive tuberculosis cases in ten township health centres across Yangon, the largest city in Myanmar, to produce an electronic tuberculosis database. We conducted a descriptive cross-sectional analysis of sex differences in tuberculosis diagnoses at the township health centres. We also analysed national prevalence survey data to calculate additional case finding in men and women by using sputum culture when smear microscopy was negative, and estimated the sex-specific impact of using a more sensitive diagnostic tool at township health centres. Results Overall, only 514 (30 %) out of 1371 new smear positive tuberculosis patients diagnosed at the township health centres were female. The proportion of female patients varied by township (from 21 % to 37 %, p = 0.0172), month of diagnosis (37 % in February 2015 and 23 % in March 2015 p = 0.0004) and age group (26 % in 25–64 years and 49 % in 18–25 years, p < 0.0001). Smear microscopy grading of sputum specimens was not substantially different between sexes. The prevalence survey analysis indicated that the use of a more sensitive diagnostic tool could result in the proportion of females diagnosed at township health centres increasing to 36 % from 30 %. Conclusions Our study, which is the first to systematically compile and analyse routine operational data from tuberculosis diagnostic centres in Myanmar, found that substantially fewer women than men were diagnosed in all study townships. The sex ratio of newly diagnosed cases varied by age group, month of diagnosis and township of diagnosis. Low sensitivity of tuberculosis diagnosis may lead to a potential under-diagnosis of tuberculosis among women.
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Affiliation(s)
- M S Khan
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Satharanauskwisit Building, 420/1 Rajwithi Road, Bangkok, 10400, Thailand. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - T M Khine
- National Tuberculosis Programme, Yangon, Myanmar
| | - C Hutchison
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Satharanauskwisit Building, 420/1 Rajwithi Road, Bangkok, 10400, Thailand
| | - R J Coker
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Satharanauskwisit Building, 420/1 Rajwithi Road, Bangkok, 10400, Thailand.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - K M Hane
- Family Health International Myanmar Office, Yangon, Myanmar
| | - A L Innes
- Family Health International Asia Pacific Regional Office, Bangkok, Thailand
| | - S Aung
- National Tuberculosis Programme, Yangon, Myanmar
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Ross JM, Cattamanchi A, Miller CR, Tatem AJ, Katamba A, Haguma P, Handley MA, Davis JL. Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems. Am J Trop Med Hyg 2015; 93:733-8. [PMID: 26217044 PMCID: PMC4596591 DOI: 10.4269/ajtmh.14-0754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/23/2015] [Indexed: 11/07/2022] Open
Abstract
Reducing geographic barriers to tuberculosis (TB) care is a priority in high-burden countries where patients frequently initiate, but do not complete, the multi-day TB evaluation process. Using routine cross-sectional study from six primary-health clinics in rural Uganda from 2009 to 2012, we explored whether geographic barriers affect completion of TB evaluation among adults with unexplained chronic cough. We measured distance from home parish to health center and calculated individual travel time using a geographic information systems technique incorporating roads, land cover, and slope, and measured its association with completion of TB evaluation. In 264,511 patient encounters, 4,640 adults (1.8%) had sputum smear microscopy ordered; 2,783 (60%) completed TB evaluation. Median travel time was 68 minutes for patients with TB examination ordered compared with 60 minutes without (P < 0.010). Travel time differed between those who did and did not complete TB evaluation at only one of six clinics, whereas distance to care did not differ at any of them. Neither distance nor travel time predicted completion of TB evaluation in rural Uganda, although limited detail in road and village maps restricted full implementation of these mapping techniques. Better data are needed on geographic barriers to access clinics offering TB services to improve TB diagnosis.
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Affiliation(s)
- Jennifer M Ross
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
| | - Adithya Cattamanchi
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
| | - Cecily R Miller
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
| | - Andrew J Tatem
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
| | - Achilles Katamba
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
| | - Priscilla Haguma
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
| | - Margaret A Handley
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
| | - J Lucian Davis
- Division of Infectious Diseases, University of Washington, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Curry International Tuberculosis Center, San Francisco, California; Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; MU-UCSF Research Collaboration, Clinical Epidemiology Unit, Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Department of Epidemiology of Microbial Diseases, School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, School of Medicine, Yale University, New Haven, Connecticut
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