Tuberculosis Case Finding with Combined Rapid Point-of-Care Assays (Xpert MTB/RIF and Determine TB LAM) in HIV-Positive Individuals Starting Antiretroviral Therapy in Mozambique

Marco Floridia, Fausto Ciccacci, Mauro Andreotti, Archa Hassane, Zita Sidumo, Nurja A. Magid, Horacio Sotomane, Muhlavasse David, Elsa Mutemba, Junia Cebola, Remigio Josè Mugunhe, Fabio Riccardi, Maria Cristina Marazzi, Marina Giuliano, Leonardo Palombi, Sandro Mancinelli

Research output: Contribution to journalArticle

Abstract

Background Tuberculosis is a major health concern in several countries, and effective diagnostic algorithms for use in human immunodeficiency virus (HIV)-positive patients are urgently needed. Methods At prescription of antiretroviral therapy, all patients in 3 Mozambican health centers were screened for tuberculosis, with a combined approach: World Health Organization (WHO) 4-symptom screening (fever, cough, night sweats, and weight loss), a rapid test detecting mycobacterial lipoarabinomannan in urine (Determine TB LAM), and a molecular assay performed on a sputum sample (Xpert MTB/RIF; repeated if first result was negative). Patients with positive LAM or Xpert MTB/RIF results were referred for tuberculosis treatment. Results Among 972 patients with a complete diagnostic algorithm (58.5% female; median CD4 cell count, 278/μL; WHO HIV stage I, 66.8%), 98 (10.1%) tested positive with Xpert (90, 9.3%) or LAM (34, 3.5%) assays. Compared with a single-test Xpert strategy, dual Xpert tests improved case finding by 21.6%, LAM testing alone improved it by 13.5%, and dual Xpert tests plus LAM testing improved it by 32.4%. Rifampicin resistance in Xpert-positive patients was infrequent (2.5%). Among patients with positive results, 22 of 98 (22.4%) had no symptoms at WHO 4-symptom screening. Patients with tuberculosis diagnosed had significantly lower CD4 cell counts and hemoglobin levels, more advanced WHO stage, and higher HIV RNA levels. Fifteen (15.3%) did not start tuberculosis treatment, mostly owing to rapidly deteriorating clinical conditions or logistical constraints. The median interval between start of the diagnostic algorithm and start of tuberculosis treatment was 7 days. Conclusions The prevalence of tuberculosis among Mozambican HIV-positive patients starting antiretroviral therapy was 10%, with limited rifampicin resistance. Use of combined point-of-care tests increased case finding, with a short time to treatment. Interventions are needed to remove logistical barriers and prevent presentation in very advanced HIV/tuberculosis disease.

Original languageEnglish
Pages (from-to)1878-1883
Number of pages6
JournalClinical Infectious Diseases
Volume65
Issue number11
DOIs
Publication statusPublished - Dec 1 2017

Keywords

  • Africa
  • HIV
  • LAM
  • Tuberculosis
  • Xpert MTB/RIF

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Floridia, M., Ciccacci, F., Andreotti, M., Hassane, A., Sidumo, Z., Magid, N. A., Sotomane, H., David, M., Mutemba, E., Cebola, J., Mugunhe, R. J., Riccardi, F., Marazzi, M. C., Giuliano, M., Palombi, L., & Mancinelli, S. (2017). Tuberculosis Case Finding with Combined Rapid Point-of-Care Assays (Xpert MTB/RIF and Determine TB LAM) in HIV-Positive Individuals Starting Antiretroviral Therapy in Mozambique. Clinical Infectious Diseases, 65(11), 1878-1883. https://doi.org/10.1093/cid/cix641