TY - JOUR
T1 - Yield and efficiency of novel intensified tuberculosis case-finding algorithms for people living with HIV
AU - Yoon, Christina
AU - Semitala, Fred C.
AU - Asege, Lucy
AU - Katende, Jane
AU - Mwebe, Sandra
AU - Andama, Alfred O.
AU - Atuhumuza, Elly
AU - Nakaye, Martha
AU - Armstrong, Derek T.
AU - Dowdy, David W.
AU - McCulloch, Charles E.
AU - Kamya, Moses
AU - Cattamanchi, Adithya
N1 - Funding Information:
Supported by the NIH/National Institute of Allergy and Infectious Diseases (K23 AI114363, C.Y.); NIH and University of California, San Francisco Gladstone Institute of Virology and Immunology Center for AIDS Research (P30 AI027763, C.Y.); the University of California, San Francisco Nina Ireland Program for Lung Health (C.Y.); and NIH/National Institute of Allergy and Infectious Diseases Presidential Emergency Plan for AIDS Relief Center for AIDS Research Administrative Supplement (P30 A120163, A.C.). The funding organizations had no role in the design, collection, analysis, and interpretation of data, or in the writing of the manuscript. The authors thank the patients and staff of the Mulago Hospital Joint AIDS Program Immune Suppression Syndrome Clinic and The AIDS Support Organization.
Funding Information:
Supported by the NIH/National Institute of Allergy and Infectious Diseases (K23 AI114363, C.Y.); NIH and University of California, San Francisco Gladstone Institute of Virology and Immunology Center for AIDS Research (P30 AI027763, C.Y.); the University of California, San Francisco Nina Ireland Program for Lung Health (C.Y.); and NIH/National Institute of Allergy and Infectious Diseases Presidential Emergency Plan for AIDS Relief Center for AIDS Research Administrative Supplement (P30 A120163, A.C.). The funding organizations had no role in the design, collection, analysis, and interpretation of data, or in the writing of the manuscript.
Publisher Copyright:
Copyright © 2019 by the American Thoracic Society.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Rationale: The recommended tuberculosis (TB) intensified case finding (ICF) algorithm for people living with HIV (symptom-based screening followed by Xpert MTB/RIF [Xpert] testing) is insufficiently sensitive and results in unnecessary Xpert testing. Objectives: To evaluate whether novel ICF algorithms combining C-reactive protein (CRP)-based screening with urine Determine TB-LAM (TB-LAM), sputum Xpert, and/or sputum culture could improve ICF yield and efficiency. Methods: We compared the yield and efficiency of novel ICF algorithms inclusive of point-of-care CRP-based TB screening and confirmatory testing with urine TB-LAM (if CD4 count <100 cells/ml), sputum Xpert, and/or a single sputum culture among consecutive people living with HIV with CD4 counts less than or equal to 350 cells/ml initiating antiretroviral therapy in Uganda. Measurements and Main Results: Of 1,245 people living with HIV, 203 (16%) had culture-confirmed TB including 101 (49%) patients with CD4 counts less than or equal to 100 cells/ml. Compared with the current ICF algorithm, point-of-care CRP-based TB screening followed by Xpert testing had similar yield (56% [95% confidence interval, 49–63] vs. 59% [95% confidence interval, 51–65]) but consumed less than half as many Xpert assays per TB case detected (9 vs. 4). Addition of TB-LAM did not significantly increase diagnostic yield relative to the current ICF algorithm but provided same-day diagnosis for 26% of TB patients with advanced HIV. Addition of a single culture to TB-LAM and Xpert substantially improved ICF yield, identifying 78% of all TB cases. Conclusions: Point-of-care CRP-based screening can improve ICF efficiency among people living with HIV. Addition of TB-LAM and a single culture to Xpert confirmatory testing could enable HIV programs to increase the speed of TB diagnosis and ICF yield.
AB - Rationale: The recommended tuberculosis (TB) intensified case finding (ICF) algorithm for people living with HIV (symptom-based screening followed by Xpert MTB/RIF [Xpert] testing) is insufficiently sensitive and results in unnecessary Xpert testing. Objectives: To evaluate whether novel ICF algorithms combining C-reactive protein (CRP)-based screening with urine Determine TB-LAM (TB-LAM), sputum Xpert, and/or sputum culture could improve ICF yield and efficiency. Methods: We compared the yield and efficiency of novel ICF algorithms inclusive of point-of-care CRP-based TB screening and confirmatory testing with urine TB-LAM (if CD4 count <100 cells/ml), sputum Xpert, and/or a single sputum culture among consecutive people living with HIV with CD4 counts less than or equal to 350 cells/ml initiating antiretroviral therapy in Uganda. Measurements and Main Results: Of 1,245 people living with HIV, 203 (16%) had culture-confirmed TB including 101 (49%) patients with CD4 counts less than or equal to 100 cells/ml. Compared with the current ICF algorithm, point-of-care CRP-based TB screening followed by Xpert testing had similar yield (56% [95% confidence interval, 49–63] vs. 59% [95% confidence interval, 51–65]) but consumed less than half as many Xpert assays per TB case detected (9 vs. 4). Addition of TB-LAM did not significantly increase diagnostic yield relative to the current ICF algorithm but provided same-day diagnosis for 26% of TB patients with advanced HIV. Addition of a single culture to TB-LAM and Xpert substantially improved ICF yield, identifying 78% of all TB cases. Conclusions: Point-of-care CRP-based screening can improve ICF efficiency among people living with HIV. Addition of TB-LAM and a single culture to Xpert confirmatory testing could enable HIV programs to increase the speed of TB diagnosis and ICF yield.
KW - C-reactive protein
KW - Intensified case finding
KW - Screening
KW - Tuberculosis
KW - Urine lipoarabinomannan
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U2 - 10.1164/rccm.201803-0490OC
DO - 10.1164/rccm.201803-0490OC
M3 - Article
C2 - 30192649
AN - SCOPUS:85062239689
SN - 1073-449X
VL - 199
SP - 643
EP - 650
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 5
ER -