NEW STUDY: Investigating latest TB screening strategy among HIV positive patients
A new study launched at Ifakara Health Institute recently will investigate the effect of an expanded tuberculosis (TB) screening strategy among HIV-positive patients admitted to hospital. This particular investigation, to go by a short name of "Exultant", will focus on the proportion of “bacteriologically confirmed TB cases” starting treatment within 72 hours of enrolment compared to testing done in only patients who are symptomatic for TB or fulfill WHO testing recommendations.
TB is the leading cause of mortality among people living with HIV. As such, only 56% of the total estimated HIV-associated TB cases were diagnosed and/or reported in 2020, according to the WHO. To close the gap and meet the WHO End TB Strategy, researchers leading this investigation believe, the expansion of Xpert Ultra tests for persons living with HIV is very crucial.
The study will last 41 months with preliminary planning beginning back in September 2019. Support and funding of the study are done by The European & Developing Countries Clinical Trials Partnership (EDCTP) - the trial funder, Foundation for Innovative Diagnostics (FIND) - the trial coordinator, and LING - in charge of contractual and financial management.
The principal investigator for this study is Dr. Robert Ndege from the Chronic Diseases Clinic of Ifakara (CDCI) and Prof. Maja Weisser will be the project leader. Additional project coordinators include Francisca Chuwa, Bernard Kivuma, Dorcas Mnzava, Swalehe Masoud, Mohammed Sasamalo, and Jerry Hella.
Previous investigations into the effectiveness of Xpert Ultra tests for TB infection among HIV-positive patients have shown that the tests provide accurate results and allow rapid initiation of treatment for TB. To get this outcome, an expanded TB screening strategy among HIV-positive patients admitted to a hospital was done on several confirmed TB cases from positive biological specimens tested by smear microscopy.
Those found positive with TB started treatment within 72 hours of the diagnosis. Comparing the Xpert Ultra tests to Ultra testing (on sputum/any tissue) and AlereLAM (on urine), the former proved to have higher sensitivity and lower specificity for TB, especially in smear‐negative participants and PLHIV.
The study involved HIV-positive adults admitted to hospitals in selected sites in Mozambique and Tanzania intending to find better ways of diagnosing TB which has been a challenge due to atypical TB symptoms and higher rates of sputum-negative among HIV patients.
You can learn more about the study here.