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Multicenter Study
. 2015 Feb 6;10(2):e0116721.
doi: 10.1371/journal.pone.0116721. eCollection 2015.

Catching the missing million: experiences in enhancing TB & DR-TB detection by providing upfront Xpert MTB/RIF testing for people living with HIV in India

Neeraj Raizada  1 , Kuldeep Singh Sachdeva  2 , Achuthan Sreenivas  3 , Shubhangi Kulsange  1 , Radhey Shyam Gupta  2 , Rahul Thakur  1 , Puneet Dewan  3 , Catharina Boehme  4 , Chinnambedu Nainarappan Paramsivan  1
Affiliations
Multicenter Study

Catching the missing million: experiences in enhancing TB & DR-TB detection by providing upfront Xpert MTB/RIF testing for people living with HIV in India

Neeraj Raizada et al. PLoS One. .

Abstract

Background: A critical challenge in providing TB care to People Living with HIV (PLHIV) is establishing an accurate bacteriological diagnosis. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents results from PLHIV taking part in a large demonstration study across India wherein upfront Xpert MTB/RIF testing was offered to all presumptive PTB cases in public health facilities.

Method: The study covered a population of 8.8 million across 18 sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each TU. All HIV-infected patients suspected of TB (both TB and Drug Resistant TB (DR-TB)) accessing public health facilities in study area were prospectively enrolled and provided upfront Xpert MTB/RIF testing.

Result: 2,787 HIV-infected presumptive pulmonary TB cases were enrolled and 867 (31.1%, 95% Confidence Interval (CI) 29.4‒32.8) HIV-infected TB cases were diagnosed under the study. Overall 27.6% (CI 25.9-29.3) of HIV-infected presumptive PTB cases were positive by Xpert MTB/RIF, compared with 12.9% (CI 11.6-14.1) who had positive sputum smears. Upfront Xpert MTB/RIF testing of presumptive PTB and DR-TB cases resulted in diagnosis of 73 (9.5%, CI 7.6‒11.8) and 16 (11.2%, CI 6.7‒17.1) rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high 97.7% (CI 89.3‒99.8), with no significant difference with or without prior history of TB treatment.

Conclusion: The study results strongly demonstrate limitations of using smear microscopy for TB diagnosis in PLHIV, leading to low TB and DR-TB detection which can potentially lead to either delayed or sub-optimal TB treatment. Our findings demonstrate the usefulness and feasibility of addressing this diagnostic gap with upfront of Xpert MTB/RIF testing, leading to overall strengthening of care and support package for PLHIV.

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Conflict of interest statement

Competing Interests: The prior approval was obtained from the institution ethics committee for the study. NR, SK, RT, CB and CNP are employed by FIND, a non-profit organization that collaborates with industry partners, including Cepheid Inc., for the development and evaluation of new diagnostic tests. These partners with whom the authors have partnered have in no way contributed to the study and would not be benefited by the results of the study. As such this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials and there is no conflict of interest to the publication of this article. The primary study data would be made available in the supplementary table as required.

Figures

Fig 1
Fig 1. Geographical location of study treatment units and the demographic classification assigned to each project treatment unit site.
Fig 2
Fig 2. Study diagnostic algorithm.
Fig 3
Fig 3. Enrolment of HIV infected presumptive TB and DR TB cases under the study and TB and Rifampicin resistant TB case detection by Xpert MTB/RIF.
See this image and copyright information in PMC

References

    1. UNAIDS report on the global AIDS epidemic (2013) Global report, Page no 4; Available: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo...
    1. TB HIV Facts 2012–2013, Available: http://www.who.int/hiv/topics/tb/tbhiv_facts_2013/en/. Accessed 2014 May 20.
    1. Dewan P, Gupta D, Williams B G, Thakur R, Bachani D, et al. (2010) National estimate of HIV sero prevalence among tuberculosis patients in India. International Journal of Tuberculosis and Lung Disease; 14(2): 247–9. Available: http://tbcindia.nic.in/pdfs/National%20estimate%20of%20HIV%20seroprevale... - PubMed
    1. World Health Organization, Global Tuberculosis report (2013), page no 9, Available: http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf?ua=1
    1. WHO policy on collaborative TB/HIV activities (2012) Guidelines for national programmes and other stakeholders (2012), Available: http://whqlibdoc.who.int/publications/2012/9789241503006_eng.pdf - PubMed

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