Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa

BMC Infectious Diseases

Sabina Govere¹  Bright Mhlongo¹  Hilary Thulare¹  Leah S. Forman²  Ingrid V. Bassett³  Elena Losina⁴  Simone C. Frank⁴ 

[1] AIDS Healthcare Foundation;Data Coordinating Center, Boston University School of Public Health;Division of Infectious Disease, Massachusetts General Hospital;Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital;

关键词: Tuberculosis;    Test & Treat;    GeneXpert MTB/RIF;    Community-based screening;   

DOI  :  10.1186/s12879-019-3738-4

来源: DOAJ

【 摘 要 】

Abstract Background Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. Methods We conducted a pilot randomized trial to evaluate the impact of GeneXpert screening on a mobile HIV testing unit. Adults (≥18y) underwent rapid HIV testing and TB symptom screening and were randomized to usual mobile unit care (providing sputum on the mobile unit sent out for GeneXpert testing) or the “Test & Treat TB” intervention with immediate GeneXpert testing. Symptomatic participants in usual care produced sputum that was sent for hospital-based GeneXpert testing; participants were contacted ~ 7 days later with results. In the “Test & Treat TB” intervention, HIV-infected or HIV-uninfected/TB symptomatic participants underwent GeneXpert testing on the mobile unit. GeneXpert+ participants received expedited TB treatment initiation, monthly SMS reminders and non-cash incentives. We assessed 6-month TB treatment outcomes. Results 4815 were eligible and enrolled; median age was 27 years (IQR 22 to 35). TB symptoms included cough (5%), weight loss (4%), night sweats (4%), and fever (3%). 42% of eligible participants produced sputum (intervention: 56%; usual care: 26%). Seven participants tested GeneXpert+, six in the intervention (3%, 95% CI 1%, 5%) and one in usual care (1%, 95% CI 0%, 6%). 5 of 6 intervention participants completed TB treatment; the GeneXpert+ participant in usual care did not. Conclusion GeneXpert MTB/RIF screening on a mobile HIV testing unit is feasible. Yield for GeneXpert+ TB was low, however, the “Test & Treat TB” strategy led to high rates of TB treatment completion. Trial registration This study was registered on November 21, 2014 at ClinicalTrials.gov (NCT02298309).

【 授权许可】

Unknown