A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania.
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.
Type
Journal articleSubject
AdultAntitubercular 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
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http://hdl.handle.net/10161/13774Published Version (Please cite this version)
10.1186/1471-2334-14-89Publication Info
(2014). A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania. BMC Infect Dis, 14. pp. 89. 10.1186/1471-2334-14-89. Retrieved from http://hdl.handle.net/10161/13774.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Andrew Crump
Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University’s
collaborative research program based at Kilimanjaro Christian Medical Centre and Director
of Tanzania Operations for the Duke Global Health Institute. I oversee the design
and implementation of research studies on infectious diseases, particularly febrile
illness, invasive bacterial disease, HIV-associated opportunistic infections, clinical
trials of antiretroviral therapy and prevention of mother-to-child tr
Coleen Kathryn Cunningham
Professor of Pediatrics
Dr. Cunningham is a pediatric infectious diseases physician who has focused her research
on the prevention and treatment of HIV infection in children. She has also played
important roles in evaluation of vaccines for other infectious diseases and recently
has worked on Ebola virus treatment studies. She is currently working on studies
of active and passive immunization to prevent HIV transmission in neonates born to
HIV infected women.
Carol Dukes Hamilton
Consulting Professor in the Department of Medicine
Dr. Carol Dukes Hamilton is an Infectious Diseases-trained Associate Professor of
Medicine, whose research program focus is to optimize strategies to cure and prevent
development of tuberculosis (TB). She has a special interest in TB in HIV-infected
individuals and her clinical outpatient work is largely comprised of patients with
HIV/AIDS. She is actively involved in both clinical trials and epidemiologic studies.
She currently has independent research support and has a history of consi
Jason Eric Stout
Professor of Medicine
My research focuses on the epidemiology, natural history, and treatment of tuberculosis
and nontuberculous mycobacterial infections. I am also interested in the impact of
HIV infection on mycobacterial infection and disease, and in examining health disparities
as they relate to infectious diseases, particularly in immigrant populations.
Nathan Maclyn Thielman
Professor of Medicine
Broadly, my research focuses on a range of clinical and social issues that affect
persons living with or at risk for HIV infection in resource-poor settings. In Tanzania,
our group is applying novel methods to optimize HIV testing uptake among high-risk
groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form
of stated preference survey research, is a robust tool for identifying (a) which characteristics
of HIV testing options are most preferred by different populati
Alphabetical list of authors with Scholars@Duke profiles.
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