Tuberculosis Case Finding With Combined Rapid Point-of-Care Assays (Xpert MTB/RIF and Determine TB LAM) in HIV-Positive Individuals Starting Antiretroviral Therapy in Mozambique.

摘要: BACKGROUND: Tuberculosis is a major health concern in several countries, and effective diagnostic algorithms for use human immunodeficiency virus (HIV)-positive patients are urgently needed. METHODS: At prescription of antiretroviral therapy, all 3 Mozambican centers were screened tuberculosis, with combined approach: World Health Organization (WHO) 4-symptom screening (fever, cough, night sweats, weight loss), rapid test detecting mycobacterial lipoarabinomannan urine (Determine TB LAM), molecular assay performed on sputum sample (Xpert MTB/RIF; repeated if first result was negative). Patients positive LAM or Xpert MTB/RIF results referred tuberculosis treatment. RESULTS: Among 972 complete algorithm (58.5% female; median CD4 cell count, 278/μL; WHO HIV stage I, 66.8%), 98 (10.1%) tested (90, 9.3%) (34, 3.5%) assays. Compared single-test strategy, dual tests improved case finding by 21.6%, testing alone it 13.5%, plus 32.4%. Rifampicin resistance Xpert-positive infrequent (2.5%). Among results, 22 (22.4%) had no symptoms at screening. diagnosed significantly lower counts hemoglobin levels, more advanced stage, higher RNA levels. Fifteen (15.3%) did not start treatment, mostly owing to rapidly deteriorating clinical conditions logistical constraints. The interval between the treatment 7 days. CONCLUSIONS: The prevalence among HIV-positive starting therapy 10%, limited rifampicin resistance. Use point-of-care increased finding, short time treatment. Interventions needed remove barriers prevent presentation very HIV/tuberculosis disease.