Efficiency of sputum microscopy in diagnosis of tuberculosis and cost-effectiveness of 8-month versus 6-month regimen for treatment of new smear-positive pulmonary tuberculosis in a setting of high HIV prevalence

Proper and efficient diagnosis and treatment of tuberculosis are cornerstones for the control of tuberculosis in developing countries. Diagnosis of tuberculosis in several developing countries follows the World Health Organization (WHO) and International Union Against Lung Disease (IUATLD) recommendation of examining three smear examinations among tuberculosis suspects before excluding smear positive tuberculosis. Chapter one examines the efficiency of the third serial sputum smear examination in the diagnosis of pulmonary tuberculosis (PTB) in a high burden country in Africa (Uganda) and a high incidence country in Europe (Moldova). Results from the study show that it is not efficient to use the third serial sputum smear examination to diagnose tuberculosis as the number of examinations required to identify an additional smear-positive tuberculosis case exceeded by far what the responsible authorities in both countries formulated as an acceptable maximum to make three serial smears a routine requirement. So it is appropriate to determine policy locally rather than follow global blanket recommendations.;Chapter 2 aims at improving the estimate of burden tuberculosis to the community by measuring health-related Quality of Life (QoL) associated with tuberculosis among patients and members of the general population in Uganda. The European Quality of Life Instrument 5-Dimensions instrument (EQ-5D) was adopted, translated, and modified and used to measure QoL associated with tuberculosis. Though the study indicate that it is feasible to measure health related QoL associated with tuberculosis in the setting, the results of the study, most so for members of the general population did not correlate well with the other two measures, Time Trade Off (TTO), and Visual Analogue Scale (VAS), that were also used to measure QoL associated with tuberculosis in the same study population. This is going to require further investigation.;Chapter three utilizes QoL information generated in chapter 2 to conduct a cost-effectiveness analysis of the eight-month versus the six-month strategy for the management of HIV-uninfected patients with smear-positive PTB. Results indicate that in both the current Ugandan situation where there is no treatment for MDR-TB and assuming an ideal situation if treatment for MDR-TB was available, the six-month strategy is better than the eight-month strategy for the management of new HIV-negative patients with PTB. Provision of treatment for MDR-TB is cost-effective and will reduce overall mortality due to tuberculosis, however, it will increase the cost of administering drugs by Direct Observation of Therapy (DOT). Thus it is important to ensure that resources for DOT are available and sustainable to prevent extra-drug resistant tuberculosis.