***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: SETTING Thirteen primary health care ( PHC ) facilities in the Stellenbosch District , South Africa . OBJECTIVE To assess the use of a sputum register to evaluate the tuberculosis ( TB ) diagnostic process and the initiation of TB treatment in selected PHC facilities in a country with a central ised laboratory system . DESIGN This prospect i ve study was conducted between April 2004 and March 2005 . The names of all individuals su bmi tting sputum sample s for TB testing were noted in a newly introduced sputum register . We classified all TB suspects with two positive smears as TB cases and consulted TB treatment registers until 3 months after sputum su bmi ssion to determine how many had started treatment . RESULTS A total of 4062 persons aged > or = 15 years su bmi tted sputum sample s , of whom 2484 were TB suspects . There were 2037 suspects with at least two results , 367 ( 18 % ) had at least two positive smears and 64 ( 17 % ) of these did not start treatment ( initial defaulters ) . Over the entire diagnostic process , up to 5 % of TB cases were missed , and up to 26 % did not start treatment and were not reported . CONCLUSION By correcting diagnostic weaknesses identified in the sputum register , PHC facilities will be able to detect , treat and cure a higher percentage of TB patients OBJECTIVE To assess the magnitude and reasons of initial default in pulmonary tuberculosis patients , diagnosed at Nazimabad Chest Clinic , Karachi . METHODS This prospect i ve study was conducted over five months from 1st December 2007 to 30th April 2008 . Suspected tuberculosis patients were prescribed sputum AFB ( Acid Fast Bacilli ) smears for three sample s. This study included the smear positive patients who did not collect their report and were therefore defaulters for initiation of anti-tuberculosis treatment .  These patients were contacted on phone , reasons of defaults were enquired and they were offered free treatment . RESULTS In the study period , out of 869 tuberculosis suspects , 224 were diagnosed as smear positive pulmonary tuberculosis . Of these 224 , one hundred and sixty-two got themselves registered for treatment . The remaining 62/224 ( 27.67 % ) were initial defaulters . On telephonic contact , 55 ( 88.70 % ) were traceable while 07/62 ( 11.29 % ) were Untraceable-defaulters . Twenty-four patients ( 38.70 % ) reported to the clinic and were registered for treatment . The most common reason for default was ' dissatisfaction with services at the clinic ' . CONCLUSION A high initial default for initiating Anti-Tuberculosis Therapy is a serious issue that needs to be addressed OBJECTIVE To investigate mortality rates and risk factors for death among smear-negative tuberculosis ( TB ) suspects . DESIGN Cohort study nested within a cluster-r and omised trial of community-based active case finding . Smear-negative TB suspects were followed for 12 months , with home tracing where necessary . We calculated mortality rates and used regression analysis to investigate the relationship between clinical characteristics and death . RESULTS Between February 2006 and June 2007 , 1195 smear-negative TB suspects were followed for 1136.8 person-years . Human immunodeficiency virus ( HIV ) prevalence was 63.3 % . During follow-up , 139 participants died ( 11.6 % ) and mortality rates remained high throughout ; 119 ( 16.5 % ) HIV-positive individuals and 13 ( 3.1 % ) HIV-negative individuals died ( HR = 5.8 , 95%CI 3.3 - 10.4 , P < 0.001 ) . Advanced immunosuppression was the main risk factor for death among HIV-positive participants , with CD4 count < 50 cells/μ l associated with a 13-fold increased risk of death . Antiretroviral treatment ( ART ) was initiated by only 106 ( 14.7 % ) , with long delays in accessing care . CONCLUSION HIV-positive smear-negative TB suspects are at high and sustained risk of death . Current guidelines for the management of HIV-infected TB suspects are limited , and this study adds to evidence that specific policies are required to promote earlier HIV and TB diagnosis and reduce delays in ART initiation RATIONALE Tuberculosis case-detection rates are below internationally established targets in high-burden countries .  Real-time monitoring and evaluation of adherence to widely endorsed st and ards of tuberculosis care might facilitate improved case finding . OBJECTIVES To monitor and evaluate the quality of tuberculosis case-detection and management services in a low-income country with a high incidence of tuberculosis . METHODS We prospect ively evaluated  tuberculosis diagnostic services at five primary health-care facilities in Ug and a for 1 year , after introducing a real-time , electronic performance-monitoring system . We collected data on every clinical encounter , and measured quality using indicators derived from the International St and ards of Tuberculosis Care . MEASUREMENTS AND MAIN RESULTS In 2009 , there were 62,909 adult primary -care visits . During the first quarter of 2009 , clinicians referred only 21 % of patients with cough greater than or equal to 2 weeks for sputum smear microscopy and only 71 % of patients with a positive sputum examination for tuberculosis treatment . These proportions increased to 53 % and 84 % , respectively , in the fourth quarter of 2009 . The cumulative probability that a smear-positive patient with cough greater than or equal to 2 weeks would be appropriately evaluated and referred for treatment rose from 11 % to 34 % ( P = 0.005 ) . The quarterly number of tuberculosis cases identified and prescribed treatment also increased four-fold , from 5 to 21 . CONCLUSIONS Poor adherence to internationally accepted st and ards of tuberculosis care improved after introduction of real-time performance monitoring and was associated with increased tuberculosis case detection .  Real-time monitoring and evaluation can strengthen health systems in low-income countries and facilitate operational research on the effectiveness and sustainability of interventions to improve tuberculosis case detection 
    Output:
    
Pre-treatment loss to follow-up , common in most setting s , can hinder tuberculosis control efforts .
By not counting individuals who are lost to follow-up before treatment when reporting st and ard programme indicators , NTPs underestimate case detection rates and mortality and overestimate cure rates