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. 2021 Dec 1;35(15):2531-2537.
doi: 10.1097/QAD.0000000000003031.

Feasibility and impact of near-point-of-care integrated tuberculosis/HIV testing in Malawi and Zimbabwe

Melody Wang  1 , Caroline E Boeke  1 , Maria Rosezoil Rioja  1 , Tatenda Maparo  2 , Clement Banda  3 , Chancy Chavula  3 , Andrews Gunda  3 , Jean Isaac  3 , Alexio Mangwiro  2 , Phibeon Munyaradzi Mangwendeza  2 , Jonathan Mtaula  3 , Christopher Mwase  3 , Naoko Doi  1 , Trevor Peter  1 , James Kandulu  4 , Raiva Simbi  5 , Shaukat Khan  1 , Jilian A Sacks  1
Affiliations

Feasibility and impact of near-point-of-care integrated tuberculosis/HIV testing in Malawi and Zimbabwe

Melody Wang et al. AIDS. .

Abstract

Objectives: Near-point-of-care (POC) testing for early infant diagnosis (EID) and viral load expedites clinical action and improves outcomes but requires capital investment. We assessed whether excess capacity on existing near-POC devices used for TB diagnosis could be leveraged to increase near-POC HIV molecular testing, termed integrated testing, without compromising TB services.

Design: Preimplementation/postimplementation studies in 10 health facilities in Malawi and 8 in Zimbabwe.

Methods: Timeliness of EID and viral load test results and clinical action were compared between centralized and near-POC testing using Somers' D tests (continuous indicators) and risk ratios (RR, binary indicators); TB testing/treatment rates and timeliness were analyzed preintegration/postintegration.

Results: With integration, average device utilization increased but did not exceed 55%. Despite the addition of HIV testing, TB test volumes, timeliness, and treatment initiations were maintained. Although few HIV-positive infants were identified, near-POC EID testing improved treatment initiation within 1 month by 57% compared with centralized EID [Malawi RR: 1.57, 95% confidence interval (CI) 0.98-2.52], and near-POC viral load testing significantly increased the proportion of patients with elevated viral load receiving clinical action within 1 month (Zimbabwe RR: 5.26, 95% CI 3.38-8.20; Malawi RR: 3.90, 95% CI 2.58-5.91).

Conclusion: Integrating TB/HIV testing using existing multidisease platforms is feasible and enables increased access to rapid diagnostics without disrupting existing TB services. Our results serve as an example of a novel, efficient implementation model that can increase access to critical testing services across disease silos and should be considered for additional clinical applications.

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References

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