0 Recommendations

Yield and efficiency of novel ICF algorithms for PLHIV - just accepted/e-published at AJRCCM

By Christina Yoon | 09 Sep, 2018

Hi all,
I wanted to share our recently accepted manuscript describing the yield and efficiency of 6 ICF algorithms: symptom- or C-reactive protein (CRP)-based TB screening, combined with confirmatory TB testing strategies inclusive of urine LAM, sputum Xpert and/or sputum culture. Below is the abstract and manuscript attachment (journal link: https://www.atsjournals.org/doi/abs/10.1164/rccm.201803-0490OC).

We invite your comments/concerns regarding ICF algorithms that replace symptom screening with CRP and the addition of urine LAM and culture to Xpert, considerations for other settings/populations, etc.

Rationale/Objectives: The recommended tuberculosis (TB) intensified case finding (ICF) algorithm for people living with HIV (PLHIV) – symptom-based screening followed by Xpert MTB/RIF (Xpert) testing – is insufficiently sensitive and results in unnecessary Xpert testing. We evaluated 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/Measurements: We compared the yield and efficiency of novel ICF algorithms inclusive of POC CRP-based TB screening and confirmatory testing with urine TB-LAM (if CD4 count ≤100 cells/μL), sputum Xpert, and/or a single sputum culture among consecutive PLHIV with CD4 counts ≤350 cells/uL initiating antiretroviral therapy in Uganda.

Main Results: Of 1245 PLHIV, 203 (16%) had culture-confirmed TB including 101 (49%) patients with CD4 counts ≤100 cells/μL. Compared to the current ICF algorithm, POC CRP-based TB screening followed by Xpert testing had similar yield (56% [95% CI: 49-63] vs. 59% [95% CI: 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: POC CRP-based screening can improve ICF efficiency among PLHIV. 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.



Ramesh Rana Replied at 8:39 PM, 9 Sep 2018

It will be very helpful to rule out tuberculosis in PLHIV. Looking forward for further future researches.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.