1
|
Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Metabolic characterisation of adult Ugandan patients with TB and diabetes mellitus comorbidity. Int J Tuberc Lung Dis 2023; 27:944-945. [PMID: 38042976 DOI: 10.5588/ijtld.23.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Affiliation(s)
- D Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Non-communicable Diseases Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe
| | - I Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala
| | - R Olum
- Department of Medicine, St Francis Hospital Nsambya, Kampala
| | - S Adakun
- Adult Tuberculosis Ward, Mulago National Referral, and Teaching Hospital, Kampala
| | | | | | - I Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Uganda
| |
Collapse
|
2
|
Otaalo B, Cevik M, Mwebesa E, Nabisere-Arinaitwe R, Zawedde-Muyanja S, Nampala J, Nanziri C, Alinaitwe L, Aber F, Bayigga J, Nankinga B, Laker E, Owarwo NC, Sabiiti W, Adakun S, Kirenga B, Turyahabwe S, Sloan DJ, Sekaggya-Wiltshire C. Prevalence of COVID-19 infection in TB clinics in Kampala, Uganda. Int J Tuberc Lung Dis 2023; 27:481-483. [PMID: 37231596 DOI: 10.5588/ijtld.23.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- B Otaalo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - M Cevik
- University of St Andrews, St Andrews, Scotland, UK
| | - E Mwebesa
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda, Muni University, Arua, Uganda
| | - R Nabisere-Arinaitwe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - S Zawedde-Muyanja
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - J Nampala
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - C Nanziri
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - L Alinaitwe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - F Aber
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - J Bayigga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - B Nankinga
- Makerere University College of Health Sciences, Kampala, Uganda
| | - E Laker
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - N C Owarwo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - W Sabiiti
- University of St Andrews, St Andrews, Scotland, UK
| | - S Adakun
- Mulago National Referral Hospital, Kampala, Uganda
| | - B Kirenga
- Mulago National Referral Hospital, Kampala, Uganda, Makerere University Lung institute, Kampala, Uganda
| | | | - D J Sloan
- University of St Andrews, St Andrews, Scotland, UK
| | - C Sekaggya-Wiltshire
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda, Mulago National Referral Hospital, Kampala, Uganda
| |
Collapse
|
3
|
Walusimbi S, Najjingo I, Zawedde-Muyanja S, Musaazi J, Nyombi A, Katagira W, Ssendiwala J, Muttamba W. Impact of on-site Xpert on TB diagnosis and mortality trends in Uganda. Public Health Action 2022; 12:90-95. [PMID: 35734005 PMCID: PMC9176188 DOI: 10.5588/pha.21.0085] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/19/2022] [Indexed: 01/24/2023] Open
Abstract
SETTING Since 2012, Uganda expanded the Xpert® MTB/RIF network for diagnosis of TB. OBJECTIVES We compared TB care cascades at health facilities with on-site Xpert vs. facilities that accessed the assay through specimen referral. DESIGN We analysed secondary aggregate data of the National TB and Leprosy Program (NTLP) from 2016 to 2019. We computed the proportions of notified TB cases and mortality ratios in relation to the estimated TB burden. RESULTS TB case notifications per annum increased from 24,287 in 2016 to 30,739 in 2019, and the proportion of cases diagnosed at facilities with on-site Xpert testing increased from 62% (15,070/24,287) to 81% (24,829/30,739) (P < 0.001). TB mortality at facilities with on-site Xpert decreased from 8.6% (1,302/15,070) to 7.8% (1,938/24,829) (P = 0.41), while it increased at facilities without on-site Xpert from 6.9% (638/9,217) to 8.8% (521/5,910) (P = 0.23). Furthermore, mortality among TB-HIV co-infected patients at facilities with on-site Xpert dropped from 5.0% (760/15,070) in 2016 to 4.8% (1,187/24,826) in 2019 (P = 0.84) compared to 4.4% (407/9,217) in 2016 to 5.3% (315/5,910) in 2019 (P = 0.57). CONCLUSION Wider installation and decentralisation of Xpert leads to increased case-finding. However, the impact on reduction in mortality remains limited. Interventions to address TB-related mortality in addition to Xpert roll-out are required.
Collapse
Affiliation(s)
- S. Walusimbi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
, Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda
| | - I. Najjingo
- Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda
| | - S. Zawedde-Muyanja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - J. Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - A. Nyombi
- National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Uganda
| | - W. Katagira
- Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda
| | - J. Ssendiwala
- Makerere University School of Public Health Monitoring and Evaluation Technical Support (METS) Program Uganda, Kampala, Uganda
| | - W. Muttamba
- Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda
| |
Collapse
|
4
|
Zawedde-Muyanja S, Nakanwagi A, Dongo JP, Sekadde MP, Nyinoburyo R, Ssentongo G, Detjen AK, Mugabe F, Nakawesi J, Karamagi Y, Amuge P, Kekitiinwa A, Graham SM. Decentralisation of child tuberculosis services increases case finding and uptake of preventive therapy in Uganda. Int J Tuberc Lung Dis 2019; 22:1314-1321. [PMID: 30355411 DOI: 10.5588/ijtld.18.0025] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and limited contact screening and management contribute to low case finding in TB-endemic settings. OBJECTIVE To evaluate the implementation of a pilot project that strengthened diagnosis, treatment and prevention of child TB at peripheral health facilities in Uganda. METHODS In June 2015, health care workers at peripheral health facilities were trained to diagnose and treat child TB. Community health care workers were trained to screen household TB contacts. Before-and-after analysis as well as comparisons with non-intervention districts were used to evaluate impact on caseload and treatment outcomes. RESULTS By December 2016, the average number of children (age < 15 years) diagnosed with TB increased from 45 to 108 per quarter. The proportion of child TB among all TB cases increased from 8.8% to 15%, and the proportion completing treatment increased from 65% to 82%. Of 2270 child TB contacts screened, 55 (2.4%) were diagnosed with TB. Of 910 eligible child contacts, 670 (74%) started preventive therapy, 569 (85%) of whom completed therapy. CONCLUSION The strengthening of child TB services at peripheral health facilities in Uganda was associated with increased case finding, improved treatment outcomes and the successful implementation of contact screening and management.
Collapse
Affiliation(s)
- S Zawedde-Muyanja
- International Union Against Tuberculosis and Lung Disease, Paris, France;, The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala
| | - A Nakanwagi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J P Dongo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M P Sekadde
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Baylor College of Children's Medical Foundation, Kampala
| | | | - G Ssentongo
- Baylor College of Children's Medical Foundation, Kampala
| | - A K Detjen
- International Union Against Tuberculosis and Lung Disease, Paris, France;, United Nations Children's Fund, New York, USA
| | - F Mugabe
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala
| | | | | | - P Amuge
- Baylor College of Children's Medical Foundation, Kampala
| | - A Kekitiinwa
- Baylor College of Children's Medical Foundation, Kampala
| | - S M Graham
- International Union Against Tuberculosis and Lung Disease, Paris, France;, Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Zawedde-Muyanja S, Manabe YC, Sewankambo NK, Nakiyingi L, Nakanjako D. Xpert ® MTB/RIF associated with improved treatment initiation among patients with smear-negative tuberculosis. Int J Tuberc Lung Dis 2019; 22:1475-1480. [PMID: 30606320 PMCID: PMC6306042 DOI: 10.5588/ijtld.17.0460] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Delayed diagnosis and treatment initiation of smear-negative tuberculosis (TB) patients can lead to increased morbidity and mortality, particularly among those co-infected with the human immunodeficiency virus (HIV). OBJECTIVE: To compare TB treatment initiation among smear-negative presumptive TB patients in the 6 months before and after the introduction of Xpert® MTB/RIF testing at five rural tertiary hospitals in Uganda. METHODS: Patient records of the dates and results of sputum analysis were extracted from TB laboratory registers and linked to those on treatment initiation as indicated in the TB treatment registers. The proportion of smear-negative presumptive patients who initiated anti-tuberculosis treatment was compared before and after Xpert implementation using χ2 tests. Time to treatment was analysed using Kaplan-Meier survival analysis. RESULTS: Records from 3658 patients were analysed, 1894 before and 1764 after the introduction of Xpert testing. After the introduction of Xpert, 25% (437/1764) of smear-negative presumptive TB patients underwent testing. The proportion initiated on anti-tuberculosis treatment increased from 5.9% (112/1894) to 10.8% (190/1764) (P < 0.01). However, 37% (32/87) of patients with a confirmed TB diagnosis did not initiate treatment. Time to TB treatment initiation improved from 8 to 3.5 days between the study periods. CONCLUSION: Xpert testing was associated with improved TB treatment initiation among smear-negative presumptive TB patients. Improved utilisation and linkage to treatment could improve the impact of this test on patient-centred outcomes.
Collapse
Affiliation(s)
| | - Y C Manabe
- The Infectious Diseases Institute, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N K Sewankambo
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - L Nakiyingi
- The Infectious Diseases Institute, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - D Nakanjako
- The Infectious Diseases Institute, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|