Use Of The Urine Determine LAM Test In The Context Of Tuberculosis Diagnosis Among Inpatients With HIV In Ghana: A Mixed Methods Study
Date
2024
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Frontiers in Public Health
Abstract
Background: The urine Determine LAM test has the potential to identify
tuberculosis (TB) and reduce early mortality among people living with HIV.
However, implementation of the test in practice has been slow. We aimed
to understand how a Determine LAM intervention was received and worked
in a Ghanaian in-hospital context.
Design/Methods: Nested in a Determine LAM intervention study,
we conducted a two-phase explanatory sequential mixed-methods study
at three hospitals in Ghana between January 2021 and January 2022.
We performed a quantitative survey with 81 healthcare workers (HCWs),
four qualitative focus-group discussions with 18 HCWs and 15 in-depth
HCW interviews. Integration was performed at the methods and analysis
level. Descriptive analysis, qualitative directed content analysis, and mixed
Methods of joint display were used.
Results: The gap in access to TB testing when relying on sputum GeneXpert
MTB/Rif alone was explained by difficulties in obtaining sputum samples
and an in-hospital system that relies on relatives. The Determine LAM test
procedure was experienced as easy, and most eligible patients received a test.
HCWs expressed that immediate access to Determine LAM tests empowered
them in rapid diagnosis. The HCW survey confirmed that bedside was the
most common place for determining LAM testing, but qualitative interviews
with nurses revealed concerns about patient confidentiality when performing and disclosing the test results at the bedside. Less than half of Determine
LAM-positive patients were initiated on TB treatment, and qualitative
data identified a weak link in the communication of the Determine LAM
results. Moreover, HCWs were reluctant to initiate the determination of LAM-positive
patients on TB treatment due to test-specificity concerns. The Determine
LAM intervention did not have an impact on the time to TB treatment as
expected, but patients were, in general, initiated on TB treatment rapidly.
We further identified a barrier to accessing TB treatment during weekends
and that treatment, by tradition, is administered early in the morning.
Conclusion: The Determine LAM testing was feasible and empowered
HCWs in the management of HIV-associated TB. Important gaps in routine
care and Determine LAM-enhanced TB care were often explained by the.
context. These findings may inform in-hospital quality improvement work
and scale-up of Determine LAM in similar settings.
Description
Research Article
Keywords
mixed methods, Determine LAM, tuberculosis