Title : Diagnostic practices and associated factors among TB patients in Uganda, 2022
Abstract:
Background: Effective TB diagnosis is crucial for timely management and favorable treatment outcomes. In 2022, Uganda reported achieving 100% TB case detection but only 63% of notified cases were bacteriologically confirmed. TB diagnostic tests currently in use in the country include Xpert MTB/RIF, sputum-smear microscopy, and urine lateral flow lipoarabinomannan (LF-LAM). We studied TB diagnostic practices and associated factors to inform optimization of TB case finding in Uganda.
Methods: We abstracted and analyzed secondary data on patient demographic and diagnostic methods used in 2022 from TB registers at 90 purposively-selected high-volume TB diagnostic and treatment units in six regions in Uganda. We used logistic regression to determine factors associated with diagnostic practices and adjusted for TB type, sex, agegroup and HIV status.
Results: Out of 9,526 patients whose records were analyzed, 8,860 (93%) had pulmonary TB (PTB) and 5,240 (55%) were bacteriologically confirmed, including 65% (3,401) by Xpert MTB/RIF and 28% (1,476) by LF-LAM. Only 64% (2,307/3,596) of HIV/TB co-infected patients were bacteriologically confirmed. Most adults >60 years (53%, 776/1474), children ≤14 years (71%, 1045/1473), and patients with extrapulmonary TB (EPTB) (84%, 506/600) were clinically diagnosed. Among patients clinically diagnosed with PTB, 50% (1,762/3,523) were treated on basis of a suggestive chest x-ray. HIV-positive patients had higher odds of being bacteriologically confirmed than their HIV-negative counterparts (AOR= 1.6, 95%CI: 1.5-1.7). PTB had much higher odds of being bacteriologically confirmed than EPTB (AOR= 5.8, 95%CI: 4.7-7.0.). HIV-positive patients (AOR =8.0, 95%CI: 7.0-10.0), females (AOR= 1.9, 95%CI: 1.6-2.2), and EPTB patients (AOR= 2.7, 95% CI: 1.8-4.0) had higher odds of being diagnosed with LF-LAM.
Conclusion: Our findings show under-utilization of laboratory diagnostic methods for bacteriologic confirmation of TB compared to the national requirement. More efforts to improve laboratory testing of TB before treatment should be explored.
Audience Take Away:
- The audience will acquire insight into the existing efforts and challenges regarding TB diagnosis in developing countries like Uganda specifically with regard to case finding and confirmation, who is most affected and where the gaps still lie. With this information, they might be able to develop ideas for operational/interventional research aimed at innovating solutions to address some of the issues identified with the overall goal of improving TB control globally.
