Rapid urine-based screening tests increase the yield of same-day tuberculosis diagnoses among patients living with advanced HIV disease
dc.contributor.author | Wake, Rachel M. | |
dc.contributor.author | Govender, Nelesh | |
dc.contributor.author | Omar, Shaheed Vally | |
dc.contributor.author | Ismail, Farzanah | |
dc.contributor.author | Tiemessen, Caroline T. | |
dc.contributor.author | Harrison, Thomas S. | |
dc.contributor.author | Jarvis, Joseph N. | |
dc.date.accessioned | 2023-09-19T12:17:30Z | |
dc.date.available | 2023-09-19T12:17:30Z | |
dc.date.issued | 2022-05 | |
dc.description.abstract | OBJECTIVE : Investigation of the diagnostic yield of urine-based tuberculosis (TB) screening in patients with advanced HIV disease. DESIGN : A cross-sectional screening study SETTING : HIV outpatient clinics and wards at two hospitals in Johannesburg, South Africa, between June 2015 and October 2017. PARTICIPANTS : Two hundred and one patients living with advanced HIV disease (CD4+ T-lymphocytes <100 cells/μl) attending healthcare facilities following cryptococcal antigen (CrAg) screening. INTERVENTION : Screening for TB using sputum for microscopy, culture, and Xpert MTB/Rif and urine for lipoarabinomannan (LAM) and Xpert Ultra. MAIN OUTCOME MEASURES : Proportion of positive results using each testing modality, sensitivity, and specificity of urine-based testing compared with culture, and survival outcomes during 6 months follow up. RESULTS : Urine was obtained from 177 of 181 (98%) participants and sputum from 91 (50%). Urine-based screening increased same-day diagnostic yield from 7 (4%) to 31 (17%). A positive urine test with either LAM or Xpert Ultra had 100% sensitivity (95% confidence interval, 59–100%) for detecting culture-positive TB at any site. Patients with newly diagnosed TB on urine-based screening were initiated on treatment and did not have excess mortality compared with the remainder of the cohort. CONCLUSION : Urine is an easily obtainable sample with utility for detecting TB in patients with advanced HIV disease. Combining urine and sputum-based screening in this population facilitates additional same-day TB diagnoses and early treatment initiation, potentially reducing the risk of TB-related mortality. Urine-based as well as sputum-based screening for TB should be integrated with CrAg screening in patients living with advanced HIV disease. | en_US |
dc.description.department | Medical Microbiology | en_US |
dc.description.librarian | hj2023 | en_US |
dc.description.sponsorship | Meningitis Research Foundation, the National Institute for Health Research (NIHR) through a Global Health Research Professorship using UK aid from the UK Government to support global health research and a grant from the National Institutes of Health. | en_US |
dc.description.uri | http://journals.lww.com/aidsonline | en_US |
dc.identifier.citation | Wake, R.M., Govender, N.P., Omar, S.V. et al. 2022, 'Rapid urine-based screening tests increase the yield of same-day tuberculosis diagnoses among patients living with advanced HIV disease', AIDS, vol. 36, no. 6, pp. 839-844, doi : 10.1097/QAD.0000000000003177. | en_US |
dc.identifier.issn | 0269-9370 (print) | |
dc.identifier.issn | 1473-5571 (online) | |
dc.identifier.other | 10.1097/QAD.0000000000003177 | |
dc.identifier.uri | http://hdl.handle.net/2263/92326 | |
dc.language.iso | en | en_US |
dc.publisher | Lippincott, Williams & Wilkins | en_US |
dc.rights | © 2022 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in AIDS, vol. 36, no. 6, pp. 839-844, 2022, doi : 10.1097/QAD.0000000000003177. | en_US |
dc.subject | Tuberculosis (TB) | en_US |
dc.subject | Urine-based tuberculosis | en_US |
dc.subject | Acquired immune deficiency syndrome (AIDS) | en_US |
dc.subject | Diagnostic techniques and procedures | en_US |
dc.subject | Lipoarabinomannan | en_US |
dc.subject | Point-of-care (POC) | en_US |
dc.subject | Point-of-care systems | en_US |
dc.subject | SDG-03: Good health and well-being | en_US |
dc.title | Rapid urine-based screening tests increase the yield of same-day tuberculosis diagnoses among patients living with advanced HIV disease | en_US |
dc.type | Postprint Article | en_US |
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