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dc.contributor.authorMathabire Rucker, SC
dc.contributor.authorCossa, L
dc.contributor.authorHarrison, RE
dc.contributor.authorMpunga, J
dc.contributor.authorLobo, S
dc.contributor.authorKisaka Kimupelenge, P
dc.contributor.authorMandar Kol'Ampwe, F
dc.contributor.authorAmoros Quiles, I
dc.contributor.authorMolfino, L
dc.contributor.authorSzumilin, E
dc.contributor.authorTelnov, O
dc.contributor.authorNdlovu, Z
dc.contributor.authorHuerga, H
dc.date.accessioned2019-11-12T13:10:30Z
dc.date.available2019-11-12T13:10:30Z
dc.date.issued2019-10-15
dc.date.submitted2019-11-08
dc.identifier.urihttp://hdl.handle.net/10144/619511
dc.description.abstractBackground: Determine TB-LAM is a urine-based point-of-care assay for diagnosis of tuberculosis (TB). Objective: To assess the feasibility of using LAM to diagnose TB in adult HIV-positive patients in resource-limited settings. Methods: We performed a multi-centric mixed-methods cross-sectional descriptive study in the Democratic Republic of Congo, Malawi, and Mozambique. We used the study and program monitoring tools to estimate user workload, turn-around time (TAT), and proportion of patients with LAM and sputum-based results. We conducted semi-structured interviews to assess the user acceptability of the LAM. Results: The duration of the LAM testing activity per patient was 27 min (IQR 26-29); staff continued with other duties whilst waiting for the result. More patients had a LAM versus a sputum-based result: 168/213 (78.9%) vs 77/213 (36.1%), p < 0.001 in DRC; 691/695 (99.4%) vs 429/695 (61.7%), p < 0.001 in Malawi; and 646/647 (99.8%) vs 262/647 (40.5%), p < 0.001 in Mozambique. The median TAT in minutes when LAM was performed in the consultation room was 75 (IQR 45-188) in DRC, 29 (IQR 27-39) in Malawi, and 36 (IQR 35-41) in Mozambique. In comparison, the overall median TAT for sputum-based tests (smear or GeneXpert) was 2 (IQR 1-3) days. The median time to the first anti-TB drug dose for LAM-positive patients was 155 (IQR 90-504) minutes in DRC and 90 (IQR 60-117) minutes in Mozambique. The overall inter-reader agreement for the interpretation of the LAM result as positive or negative was 98.9%, kappa 0.97 (95%CI 0.96-0.99). Overall, LAM users found the test easy to perform. Major concerns were use of the reading card and the prior requirement of CD4 results before LAM testing. Conclusion: It is feasible to implement the LAM test in low resource settings. The short TAT permitted same day initiation of TB treatment for LAM-positive patients.en_US
dc.language.isoenen_US
dc.publisherTaylor & Francisen_US
dc.rightsWith thanks to Taylor & Francis.en_US
dc.titleFeasibility of using Determine TB-LAM to diagnose tuberculosis in HIV-positive patients in programmatic conditions: a multisite study.en_US
dc.identifier.journalGlobal Health Actionen_US
refterms.dateFOA2019-11-12T13:10:30Z


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