8589356347

Clinical Infectious Diseases

MAJOR ARTICLE

Tubercuiosis Case Finding With Combined Rapid Point -of-Care Assays (Xpert MTB/RIF and Determine TB LAM) in HlV-Positive Individuals Starting Antiretroviral Therapy in Mozambiąue

Marco Ftoridia.’ Fausto Ciccacci.² Mauro Andreo^.¹ Archa Hassane.³ Zrta Sidumo.⁵ Nurja A MagkJ.³ Horacio Sotomane.⁴ Muhlawasse Datid.⁴ Elsa Mutemba.⁴ Junia Cebola.⁴ Remigio Jose Mugunhe.' Fabio Riccardi.⁴ Maria Cristina Marazzi.’ Marina Giuliano.¹ Leonardo Palombi.⁴ and Sandro Mancinelli⁴

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Baekground. Tubercuiosis is a major health concern in several countries, and eifeethre diagnostic algorithms for use in human immunodeficiency virus (HIV)-positive patients arc urgcntly needed.

Methods. At prescription of antirctroviral therapy> all patients in 3 Mozambkran health centcrs were scrccned for tubercuiosis. with a combined approach: World Health Organi/ation (WHO) 4-symptom scrccning (fever. cough, night swcats* and weight loss), a rapid test detccting mycobacterial lipoarabinomannan in urine (Determine TB LAM), and a molecular assay performed on a sputum samplc (Xpert MTB/RIF; repcated if first result was ncgative). Patients with positive LAM or Xpert MTB/RIF results were referred for tubercuiosis treatment.

Results. Among 972 patients with a complete diagnostic algorithm (58.5% female; median CD4 celi count, 278/pL; WHO HIV stage 1.66.8%), 98 (10.1%) tested positive with Xpert (90,9.3%) or LAM (34.3.5%) assays. Compared with a single-tcst Xpert strat-egy, dual Xpert tests improved case finding by 21.6%. LAM testing alonc improved it by 13.5%, and dual Xpeit tests plus LAM testing improved it by 32.4%. Rifampicin resistance in Xpert-positive patients was infrcąuent (2.5%). Among patients with positivc results* 22 of98 (22.4%) had no symptoms at WHO 4-symptom screening. Patients with tubercuiosis diagnosed had significantly lower CD4 celi counts and hemoglobin levels. morę advanced WHO stage. and higher HIV RNA leveis. Fifteen (15.3%) did not start tubercu losis treatment, mostly owing to rapidly deteriorating clinical conditions or logistical constraints. 1he median intenral between start of the diagnostic algorithm and start of tubercuiosis treatment was 7 days.

Conclusions. The prevalcncc of tubercuiosis among Mozambican HIV-positive patients starting antiretroviral therapy was 10%, with limited rifampicin resistance. Use of combined point-of-care tests inereased case finding, with a short time to treatment. lnterventions arc needed to rcmove logistical barriers and prevent presentation in vcry advanced HI Wtuberculosis disease.

Keywords. Tubercuiosis; HIV; Xpert MTB/RIF; LAM; Africa.