{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T02:40:07Z","timestamp":1767840007438,"version":"3.49.0"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2012,5,11]],"date-time":"2012-05-11T00:00:00Z","timestamp":1336694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2012,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Objective\u2002<\/jats:bold> To compare the performance of the new <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#b20\">WHO (2007)<\/jats:ext-link> diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#b17\">WHO 2003<\/jats:ext-link> guidelines used by the Ugandan National Tuberculosis Program (UgWHO03).<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> A prospective observational cohort design was used at Reach Out Mbuya Parish HIV\/AIDS Initiative, an urban slum community\u2010based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV\u2010infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> WHO07 reduced the time to diagnosis of smear\u2010negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear\u2010negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 <jats:italic>vs.<\/jats:italic> 28.5\u2003days, <jats:italic>P<\/jats:italic>\u2003=\u20030.003). Diagnostic specificity and sensitivity [95% confidence intervals (CIs)] for smear\u2010negative PTB were higher at the rural hospital compared with the urban ASO: [98% (93\u2013100%) <jats:italic>vs.<\/jats:italic> 86% (77\u201392%), <jats:italic>P\u2003=\u2003<\/jats:italic>0.001] and [95% (72\u2013100%) <jats:italic>vs.<\/jats:italic> 90% (54\u201399%), <jats:italic>P\u2003<\/jats:italic>&gt;<jats:italic>\u2003<\/jats:italic>0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow\u2010up appointments and poor adherence by healthcare workers to algorithms.<\/jats:p><jats:p><jats:bold>Conclusion\u2002<\/jats:bold> At both sites, WHO07 expedited diagnosis of smear\u2010negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource\u2010limited settings.<\/jats:p>","DOI":"10.1111\/j.1365-3156.2012.03003.x","type":"journal-article","created":{"date-parts":[[2012,5,11]],"date-time":"2012-05-11T11:05:13Z","timestamp":1336734313000},"page":"884-895","source":"Crossref","is-referenced-by-count":16,"title":["Performance of the new WHO diagnostic algorithm for smear\u2010negative pulmonary tuberculosis in HIV prevalent settings: a multisite study in Uganda"],"prefix":"10.1111","volume":"17","author":[{"given":"Stella\u2010Talisuna","family":"Alamo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Setor","family":"Kunutsor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Walley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janine","family":"Thoulass","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan","family":"Evans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Muchuro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Matovu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elly","family":"Katabira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,5,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0041-3879(80)90001-X"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.152.5.7582296"},{"key":"e_1_2_8_4_1","first-page":"945","article-title":"Accuracy of routine diagnosis of pulmonary tuberculosis in an area of high HIV prevalence","volume":"8","author":"Apers L","year":"2004","journal-title":"The International Journal of Tuberculosis and Lung Disease"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181988375"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03490120095035"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60284-0"},{"key":"e_1_2_8_8_1","first-page":"946","article-title":"Critical appraisal of current recommendations and practices for tuberculosis sputum smear microscopy","volume":"11","author":"Gilpin C","year":"2007","journal-title":"The International Journal of Tuberculosis and Lung Disease"},{"key":"e_1_2_8_9_1","first-page":"847","article-title":"\u2018Smear\u2010negative\u2019 pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence","volume":"5","author":"Hargreaves NJ","year":"2001","journal-title":"The International Journal of Tuberculosis and Lung Disease"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1085700"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.49.5.511"},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/004947559302300402","article-title":"Sputum smear negative pulmonary tuberculosis","volume":"23","author":"Parry CM","year":"1993","journal-title":"Tropical Doctor"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0962-8479(95)90583-9"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00609-1"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2006.01559.x"},{"key":"e_1_2_8_16_1","unstructured":"Uganda AIDS Commission(2009)National HIV & AIDS Stakeholders & Services Mapping Report.http:\/\/data.unaids.org\/pub\/Report\/2010\/uganda_2010_country_progress_report_en.pd."},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3182243a8c"},{"key":"e_1_2_8_18_1","volume-title":"Treatment of Tuberculosis: Guidelines for National Programmes","author":"WHO","year":"2003"},{"key":"e_1_2_8_19_1","volume-title":"Interim Policy on Collaborative HIV TB Activities","author":"WHO","year":"2004"},{"key":"e_1_2_8_20_1","volume-title":"Tuberculosis Factsheet","author":"WHO","year":"2006"},{"key":"e_1_2_8_21_1","volume-title":"Improving the Diagnosis and Treatment of Smear\u2010Negative Pulmonary and Extra\u2010Pulmonary Tuberculosis Among Adults and Adolescents: Recommendations for HIV\u2010Prevalent and Resource\u2010Constrained Settings","author":"WHO","year":"2007"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(97)90264-9"}],"container-title":["Tropical Medicine &amp; 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