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Ditondo P, Luemba A, Chuy RI, Mucinya G, Ade S. Contribution des diagnostics au points de service dans l’identification de la maladie à VIH avancée. Public Health Action 2023; 13:7-12. [PMID: 37529556 PMCID: PMC10380412 DOI: 10.5588/pha.23.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Médecins Sans Frontières Belgium installed point-of-care (POC) diagnostics for the early detection of advanced HIV disease (AHD), and in its presence, TB and cryptococcosis, in six health centres (Kasai, St Ambroise, St Joseph, Libondi, Lisanga and Kimia) in Kinshasa, Democratic Republic of the Congo (DRC). OBJECTIVE To document their contribution to the diagnosis of these conditions. METHOD This is a retrospective cross-sectional study of HIV-positive adolescents and adults admitted with suspected AHD. A comparison 2 years before and 2 years after installation of POC was performed. RESULTS A total of 745 and 887 patients were included before and after POC, respectively. The mean age was 39.7 years (standard deviation [SD] 12.04); 66% (n = 1,077) were women. Patients with CD4 counts increased from 40.3% (n = 300) to 64.4% (n = 573) (P < 0.001). After the installation of POC, they ranged from 47.8% (Lisanga) to 97.1% (Kasai). The proportion of AHD was comparable (n = 158, 52.7% vs. n = 288, 50.3%; P = 0.779). Among patients with AHD, TB was detected in 28.5% (n = 82), of which 41.5% (n = 34) were confirmed; cryptococcosis was detected in 24.7% (n = 71), of which 9.9% (n = 7) were confirmed. Disparities between centres were observed. CONCLUSION The POCs have increased patient access to CD4 testing and diagnosis of AHD in the six centres in DRC. However, actions are required to improve this performance, including screening for TB and cryptococcosis.
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Affiliation(s)
- P Ditondo
- Médecins Sans Frontières Belgique, Kinshasa, RDC
| | - A Luemba
- Médecins Sans Frontières Belgique, Kinshasa, RDC
| | - R Ingwe Chuy
- Programme National de Lutte Contre le VIH/SIDA, Kinshasa, RDC
| | - G Mucinya
- Médecins Sans Frontières Belgique, Kinshasa, RDC
| | - S Ade
- Faculté de Médecine, Université de Parakou, Parakou, Bénin
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Spooner E, Reddy S, Ntoyanto S, Sakadavan Y, Reddy T, Mahomed S, Mlisana K, Dlamini M, Daniels B, Luthuli N, Ngomane N, Kiepiela P, Coutsoudis A. TB testing in HIV-positive patients prior to antiretroviral treatment. Int J Tuberc Lung Dis 2022; 26:224-231. [PMID: 35197162 PMCID: PMC8886959 DOI: 10.5588/ijtld.21.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: TB diagnosis in patients with HIV is challenging due to the lower sensitivities across tests. Molecular tests are preferred and the Xpert® MTB/RIF assay has limitations in lower-income settings. We evaluated the performance of loop-mediated isothermal amplification (LAMP) and the lipoarabinomannan (LAM) test in HIV-positive, ART-naïve clinic patients.METHODS: A total of 783 eligible patients were enrolled; three spot sputum samples of 646 patients were tested using TB-LAMP, Xpert, smear microscopy and culture, while 649 patients had TB-LAM testing. Sensitivity, specificity, and negative and positive predictive values were estimated with 95% confidence intervals.RESULTS: Sensitivities for smear microscopy, TB-LAMP and Xpert were respectively 50%, 63% and 74% compared to culture, with specificities of respectively 99.2%, 98.5% and 97.5%. An additional eight were positive on TB-LAM alone. Seventy TB patients (9%) were detected using standard-of-care testing, an additional 27 (3%) were detected using study testing. Treatment was initiated in 57/70 (81%) clinic patients, but only in 56% (57/97) of all those with positive TB tests; 4/8 multidrug-resistant samples were detected using Xpert.CONCLUSION: TB diagnostics continue to miss cases in this high-burden setting. TB-LAMP was more sensitive than smear microscopy, and if followed by culture and drug susceptibility testing as required, can diagnose TB in HIV-positive patients. TB-LAM is a useful add-in test and both tests at the point-of-care would maximise yield.
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Affiliation(s)
- E Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - S Reddy
- South African Medical Research Council, Durban, South Africa
| | - S Ntoyanto
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Y Sakadavan
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - S Mahomed
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa, Centre for AIDS Programme Research in South Africa, Durban, South Africa
| | - K Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - M Dlamini
- Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - B Daniels
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - N Luthuli
- EThekwini Health Unit, EThekwini Municipality, Durban, South Africa
| | - N Ngomane
- Occupational Health, Durban, South Africa
| | - P Kiepiela
- South African Medical Research Council, Durban, South Africa
| | - A Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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