A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania
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Reddy, Elizabeth A, et al. A Randomized Controlled Trial of Standard Versus Intensified Tuberculosis Diagnostics On Treatment Decisions by Physicians In Northern Tanzania. BioMed Central Ltd, 2014. https://doi.org/10.17615/r0qj-4318APA
Reddy, E., Njau, B., Morpeth, S., Lancaster, K., Tribble, A., Maro, V., Msuya, L., Morrissey, A., Kibiki, G., Thielman, N., Cunningham, C., Schimana, W., Shao, J., Chow, S., Stout, J., Crump, J., Bartlett, J., & Hamilton, C. (2014). A randomized controlled trial of standard versus intensified tuberculosis diagnostics on treatment decisions by physicians in Northern Tanzania. BioMed Central Ltd. https://doi.org/10.17615/r0qj-4318Chicago
Reddy, Elizabeth A., Boniface N Njau, Susan C Morpeth, Kathryn Lancaster, Alison C Tribble, Venance P Maro, Levina J Msuya et al. 2014. A Randomized Controlled Trial of Standard Versus Intensified Tuberculosis Diagnostics On Treatment Decisions by Physicians In Northern Tanzania. BioMed Central Ltd. https://doi.org/10.17615/r0qj-4318- Creator
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Reddy, Elizabeth A.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Box 3010, CCFCC Duke Projects, Moshi, Tanzania
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Njau, Boniface N.
- Other Affiliation: Kilimanjaro Christian Medical Centre, Box 3010, CCFCC Duke Projects, Moshi, Tanzania
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Morpeth, Susan C.
- Other Affiliation: KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Lancaster, Kathryn
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology
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Tribble, Alison C.
- Other Affiliation: Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Maro, Venance P.
- Other Affiliation: Kilimanjaro Christian Medical Centre, Box 3010, CCFCC Duke Projects, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Msuya, Levina J.
- Other Affiliation: Kilimanjaro Christian Medical Centre, Box 3010, CCFCC Duke Projects, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Morrissey, Anne B.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA
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Kibiki, Gibson S.
- Other Affiliation: Kilimanjaro Christian Medical Centre, Box 3010, CCFCC Duke Projects, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Thielman, Nathan M.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
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Cunningham, Coleen K.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA
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Schimana, Werner
- Other Affiliation: Elizabeth Glaser Pediatric AIDS Foundation Tanzania, Dar Es Salaam, Tanzania
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Shao, John F.
- Other Affiliation: Kilimanjaro Christian Medical Centre, Box 3010, CCFCC Duke Projects, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Chow, Shein-Chung
- Other Affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Stout, Jason E.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA
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Crump, John A.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA; Kilimanjaro Christian Medical University College, Moshi, Tanzania; Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Bartlett, John A.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA; Kilimanjaro Christian Medical University College, Moshi, Tanzania; Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Hamilton, Carol D.
- Other Affiliation: Duke University Medical Center, Durham, NC, USA; FHI 360, Durham, NC, USA
- Abstract
- 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.
- Date of publication
- February 20, 2014
- DOI
- Identifier
- Resource type
- Article
- Rights statement
- In Copyright
- Rights holder
- Elizabeth A Reddy et al.; licensee BioMed Central Ltd.
- License
- Journal title
- BMC Infectious Diseases
- Journal volume
- 14
- Journal issue
- 1
- Page start
- 89
- Language
- English
- Is the article or chapter peer-reviewed?
- Yes
- ISSN
- 1471-2334
- Bibliographic citation
- BMC Infectious Diseases. 2014 Feb 20;14(1):89
- Publisher
- BioMed Central Ltd
- Access right
- Open Access
- Date uploaded
- July 15, 2016
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