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Tuberculosis (INCO)

A System Approach to Optimising Diagnosis of Smear-Negative Tuberculosis in High and Low Prevalence Countries of South America
Framework programme:
Project number:
EC contribution:
€ 857 000
48 months
Starting date:
1 October 2001


Smear-negative pulmonary tuberculosis (SNPTB) is a problem, both for clinicians and for tuberculosis programme managers. This research project approaches SNPTB from three different perspectives: the laboratory perspective, by testing the feasibility of more valid and efficient methods for quality assurance of smear-microscopy; the clinical perspective, by testing the clinical audit cycle as a method to improve the quality management of smear-negative tuberculosis suspects and the validity of diagnostic work-up; and the health service organisation perspective, in relation to (de)centralisation of different elements of the diagnosis of smear-negative tuberculosis. This study will contrast high and low incidence, centralised and decentralised, and urban and rural settings. HIV-related aspects will be examined and special emphasis will be given to the operationalisation and dissemination of study findings.


The general objective is to evaluate three different strategies to improve the diagnosis of smear-negative pulmonary tuberculosis in South America. The specific objectives are:

1) Laboratory strategy: to test novel approaches for quality assurance of direct smear microscopy, in both low-incidence, and high-incidence countries
2) Clinical strategy: to evaluate the improvement in the clinical management of smear-negative TB suspects and TB patients that can be reached through the audit cycle of the existing procedures, for both HIV-infected, and HIV-uninfected patients
3) Health system strategy: to study the effects of extensive (de)centralisation of microscopy diagnosis, in both high and low TB incidence countries, and to identify the level of health services where the different diagnostic elements should be performed to guarantee adequate suspect management and laboratory quality control.

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