Please use this identifier to cite or link to this item: https://doi.org/10.1186/1471-2334-14-89
Title: A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania
Authors: Reddy, E.A
Njau, B.N
Morpeth, S.C
Lancaster, K.E
Tribble, A.C
Maro, V.P
Msuya, L.J
Morrissey, A.B
Kibiki, G.S
Thielman, N.M
Cunningham, C.K
Schimana, W
Shao, J.F
Chow, S.-C 
Stout, J.E
Crump, J.A
Bartlett, J.A
Hamilton, C.D
Keywords: tuberculostatic agent
acid fast bacterium
adult
article
bacterium culture
child
controlled study
diagnostic kit
diagnostic test accuracy study
DNA probe
female
follow up
gastric suction
human
lung tuberculosis
major clinical study
male
medical decision making
mortality
Mycobacterium tuberculosis
preschool child
randomized controlled trial
school child
sputum analysis
sputum smear
Tanzania
tuberculin test
complication
decision making
diagnostic test
health care quality
Human immunodeficiency virus infection
infant
microbiological examination
middle aged
treatment outcome
tuberculosis
Tuberculosis, Pulmonary
Adult
Antitubercular Agents
Bacteriological Techniques
Child, Preschool
Decision Making
Diagnostic Tests, Routine
Female
HIV Infections
Humans
Infant
Male
Middle Aged
Mycobacterium tuberculosis
Standard of Care
Tanzania
Treatment Outcome
Tuberculosis
Tuberculosis, Pulmonary
Issue Date: 2014
Citation: Reddy, E.A, Njau, B.N, Morpeth, S.C, Lancaster, K.E, Tribble, A.C, Maro, V.P, Msuya, L.J, Morrissey, A.B, Kibiki, G.S, Thielman, N.M, Cunningham, C.K, Schimana, W, Shao, J.F, Chow, S.-C, Stout, J.E, Crump, J.A, Bartlett, J.A, Hamilton, C.D (2014). A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania. BMC Infectious Diseases 14 (1) : 89. ScholarBank@NUS Repository. https://doi.org/10.1186/1471-2334-14-89
Rights: Attribution 4.0 International
Abstract: Background: Routine tuberculosis culture remains unavailable in many high-burden areas, including Tanzania. This study sought to determine the impact of providing mycobacterial culture results over standard of care [unconcentrated acid-fast (AFB) smears] on management of persons with suspected tuberculosis. Methods: Adults and children with suspected tuberculosis were randomized to standard (direct AFB smear only) or intensified (concentrated AFB smear and tuberculosis culture) diagnostics and followed for 8 weeks. The primary endpoint was appropriate treatment (i.e. antituberculosis therapy for those with tuberculosis, no antituberculous therapy for those without tuberculosis). Results: Seventy participants were randomized to standard (n = 37, 53%) or intensive (n = 33, 47%) diagnostics. At 8 weeks, 100% (n = 22) of participants in follow up randomized to intensive diagnostics were receiving appropriate care, vs. 22 (88%) of 25 participants randomized to standard diagnostics (p = 0.14). Overall, 18 (26%) participants died; antituberculosis therapy was associated with lower mortality (9% who received antiuberculosis treatment died vs. 26% who did not, p = 0.04). Conclusions: Under field conditions in a high burden setting, the impact of intensified diagnostics was blunted by high early mortality. Enhanced availability of rapid diagnostics must be linked to earlier access to care for outcomes to improve. © 2014 Reddy et al.; licensee BioMed Central Ltd.
Source Title: BMC Infectious Diseases
URI: https://scholarbank.nus.edu.sg/handle/10635/181508
ISSN: 14712334
DOI: 10.1186/1471-2334-14-89
Rights: Attribution 4.0 International
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