Performance of Xpert ® MTB/RIF and Determine™ TB-LAM Ag in HIV-infected adults in peri-urban sites in Zambia.

Autor:	Kasaro MP; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Chilyabanyama ON; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Shah NS; Centers for Disease Control and Prevention, Atlanta, GA, USA., Muluka B; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Kapata N; Ministry of Health Zambia National TB Programme, Lusaka, Zambia., Krüüner A; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Mwaba I; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Kaunda K; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Coggin WL; Centers for Disease Control and Prevention, Atlanta, GA, USA., Wen XJ; Centers for Disease Control and Prevention, Atlanta, GA, USA., Henostroza G; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; University of Alabama at Birmingham, Birmingham, AL, USA., Reid S; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; University of Alabama at Birmingham, Birmingham, AL, USA.
Jazyk:	angličtina
Zdroj:	Public health action [Public Health Action] 2020 Dec 21; Vol. 10 (4), pp. 134-140.
DOI:	10.5588/pha.20.0010
Abstrakt:	Setting: Peri-urban health facilities providing HIV and TB care in Zambia. Objective: To evaluate 1) the impact of Xpert ® MTB/RIF on time-to-diagnosis, treatment initiation, and outcomes among adult people living with HIV (PLHIV) on antiretroviral therapy (ART); and 2) the diagnostic performance of Xpert and Determine™ TB-LAM Ag assays. Design: Quasi-experimental study design with the first cohort evaluated per standard-of-care (SOC; first sputum tested using smear microscopy) and the second cohort per an algorithm using Xpert as initial test (intervention phase; IP). Xpert testing was provided onsite in Chongwe District, while samples were transported 5-10 km in Kafue District. TB was confirmed using mycobacterial culture. Results: Among 1350 PLHIV enrolled, 156 (15.4%) had confirmed TB. Time from TB evaluation to diagnosis ( P = 0.018), and from evaluation to treatment initiation ( P = 0.03) was significantly shorter for IP than for SOC. There was no difference in all-cause mortality (7.0% vs. 8.6%). TB-LAM Ag showed higher sensitivity with lower CD4 cell count: 81.8% at CD4 < 50 cells/mm 3 vs. 31.7% overall. Conclusion: Xpert improved time to diagnosis and treatment initiation, but there was no difference in all-cause mortality. High sensitivity of Determine TB-LAM Ag at lower CD4 count supports increased use in settings providing care to PLHIV, particularly with advanced HIV disease. Competing Interests: Conflicts of interest: none declared. (© 2020 The Union.)
Databáze:	MEDLINE
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