Feasibility of a multifaceted intervention to improve treatment initiation among patients diagnosed with TB using Xpert MTB/RIF testing in Uganda.
Feasibility of a multifaceted intervention to improve treatment initiation among patients diagnosed with TB using Xpert MTB/RIF testing in Uganda.
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DOI：
10.1371/journal.pone.0265035
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Manabe, Yukari C.
中科院分区：
文献类型：
--
作者：
Zawedde-Muyanja, Stella;Musaazi, Joseph;Castelnuovo, Barbara;Cattamanchi, Adithya;Katamba, Achilles;Manabe, Yukari C.
在乌干达，五分之一被诊断患有结核病的患者在确诊后两周内未开始结核病治疗。我们评估了在乌干达使用Xpert® MTB/RIF检测对被诊断患有结核病的患者改善结核病治疗启动情况的多层面干预措施。
这是在一家三级转诊医院进行的一项干预前后的研究。该干预措施以COM - B模型为依据，包括：i）开展医学教育课程，以提高医护人员对治疗前失访的程度和后果的认识；ii）修改实验室申请表，以改进患者联系信息的记录；iii）重新设计工作流程，以提高痰液检测的及时性和结果的传播。收集并比较了干预措施开始前（2019年6月至8月）和开始后（2019年10月至12月）的结核病诊断过程和结果数据。
2019年9月，在该医院举办了4次继续医学教育（CME）课程，有58名医护人员参加。在研究期间，该医院通过Xpert® MTB/RIF检测对1242名患者进行了评估（干预前679名，干预后557名）。痰液检测结果的中位周转时间从干预前的12小时（四分位间距4 - 46小时）提高到干预后的4小时（四分位间距3 - 6小时）。在确诊后两周内开始治疗的患者比例从59%（68例中的40例）提高到89%（55例中的49例）（差异30%，95%置信区间14% - 43%，p<0.01），而当日确诊的患者比例从7.4%（68例中的5例）提高到25%（55例中的14例）（差异17.6%，95%置信区间3.9% - 32.7%，p<0.01）。
这种多层面的干预措施是可行的，并使在确诊后两周内开始结核病治疗的患者比例更高。
One in five patients diagnosed with TB in Uganda are not initiated on TB treatment within two weeks of diagnosis. We evaluated a multifaceted intervention for improving TB treatment initiation among patients diagnosed with TB using Xpert® MTB/RIF testing in Uganda. This was a pre-post interventional study at one tertiary referral hospital. The intervention was informed by the COM-B model and included; i) medical education sessions to improve healthcare worker knowledge about the magnitude and consequences of pretreatment loss to follow-up; ii) modified laboratory request forms to improve recording of patient contact information; and iii) re-designed workflow processes to improve timeliness of sputum testing and results dissemination. TB diagnostic process and outcome data were collected and compared from the period before (June to August 2019) and after (October to December 2019) intervention initiation. In September 2019, four CME sessions were held at the hospital and were attended by 58 healthcare workers. During the study period, 1242 patients were evaluated by Xpert® MTB/RIF testing at the hospital (679 pre and 557 post intervention). Median turnaround time for sputum test results improved from 12 hours (IQR 4–46) in the pre-intervention period to 4 hours (IQR 3–6) in the post-intervention period. The proportion of patients started on treatment within two weeks of diagnosis improved from 59% (40/68) to 89% (49/55) (difference 30%, 95% CI 14%-43%, p<0.01) while the proportion of patients receiving a same-day diagnosis increased from 7.4% (5/68) to 25% (14/55) (difference 17.6%, 95% CI 3.9%-32.7%, p<0.01). The multifaceted intervention was feasible and resulted in a higher proportion of patients initiating TB treatment within two weeks of diagnosis.
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DOI：
10.1186/1748-5908-6-42
发表时间：
2011-04-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Michie S;van Stralen MM;West R
通讯作者：
West R
影响因子：
3.7
作者：
Sendagire I;Schim Van der Loeff M;Mubiru M;Konde-Lule J;Cobelens F
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Cobelens F
影响因子：
4.2
作者：
Manabe YC;Zawedde-Muyanja S;Burnett SM;Mugabe F;Naikoba S;Coutinho A
通讯作者：
Coutinho A
DOI：
10.1164/rccm.201012-1984oc
发表时间：
2011-08-01
影响因子：
24.7
作者：
Davis, J. Lucian;Katamba, Achilles;Cattamanchi, Adithya
通讯作者：
Cattamanchi, Adithya
影响因子：
3.2
作者：
Potter, C;Brough, R
通讯作者：
Brough, R