title: Do Instructional Videos on Sputum Submission Result in Increased Tuberculosis Case Detection? A Randomized Controlled Trial.
abstract: OBJECTIVE
  We examined the effect of an instructional video about the production of diagnostic sputum on case detection of tuberculosis (TB), and evaluated the acceptance of the video.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  We prepared a culturally adapted instructional video for sputum submission. We analyzed 200 presumptive TB cases coughing for more than two weeks who attended the outpatient department of the governmental Municipal Hospital in Mwananyamala (Dar es Salaam, Tanzania). They were randomly assigned to either receive instructions on sputum submission using the video before submission (intervention group, n = 100) or standard of care (control group, n = 100). Sputum samples were examined for volume, quality and presence of acid-fast bacilli by experienced laboratory technicians blinded to study groups.
  
  
  RESULTS
  Median age was 39.1 years (interquartile range 37.0-50.0); 94 (47%) were females, 106 (53%) were males, and 49 (24.5%) were HIV-infected. We found that the instructional video intervention was associated with detection of a higher proportion of microscopically confirmed cases (56%, 95% confidence interval [95% CI] 45.7-65.9%, sputum smear positive patients in the intervention group versus 23%, 95% CI 15.2-32.5%, in the control group, p <0.0001), an increase in volume of specimen defined as a volume ≥3ml (78%, 95% CI 68.6-85.7%, versus 45%, 95% CI 35.0-55.3%, p <0.0001), and specimens less likely to be salivary (14%, 95% CI 7.9-22.4%, versus 39%, 95% CI 29.4-49.3%, p = 0.0001). Older age, but not the HIV status or sex, modified the effectiveness of the intervention by improving it positively. When asked how well the video instructions were understood, the majority of patients in the intervention group reported to have understood the video instructions well (97%). Most of the patients thought the video would be useful in the cultural setting of Tanzania (92%).
  
  
  CONCLUSIONS
  Sputum submission instructional videos increased the yield of tuberculosis cases through better quality of sputum samples. If confirmed in larger studies, instructional videos may have a substantial effect on the case yield using sputum microscopy and also molecular tests. This low-cost strategy should be considered as part of the efforts to control TB in resource-limited settings.
  
  
  BACKGROUND
  Pan African Clinical Trials Registry PACTR201504001098231.
authors.affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Grace
authors.initials: G
authors.lastname: Mhalu
authors.affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Jerry
authors.initials: J
authors.lastname: Hella
authors.affiliation: Central Tuberculosis Reference Laboratory, Dar es Salaam, Tanzania; National Tuberculosis and Leprosy Programme, Dar es Salaam, Tanzania.
authors.forename: Basra
authors.initials: B
authors.lastname: Doulla
authors.affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Francis
authors.initials: F
authors.lastname: Mhimbira
authors.affiliation: Mwananyamala Regional Hospital, Dar es Salaam, Tanzania.
authors.forename: Hawa
authors.initials: H
authors.lastname: Mtutu
authors.affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania.
authors.forename: Helen
authors.initials: H
authors.lastname: Hiza
authors.affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sasamalo
authors.affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Liliana
authors.initials: L
authors.lastname: Rutaihwa
authors.affiliation: Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Research Center Borstel, Leibniz-Center for Medicine and Biosciences, Borstel, Germany.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Rieder
authors.affiliation: Interactive Research & Development, Lausanne, Switzerland and Pakistan.
authors.forename: Tamsyn
authors.initials: T
authors.lastname: Seimon
authors.affiliation: National Tuberculosis and Leprosy Programme, Dar es Salaam, Tanzania.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mutayoba
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Weiss
authors.affiliation: Ifakara Health Institute, Bagamoyo and Dar es Salaam, Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Fenner
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010353:Patient Education as Topic / Q000379:methods*; D013183:Sputum / Q000382:microbiology*; D011795:Surveys and Questionnaires; D013636:Tanzania; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000382:microbiology