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Point-of-care urine LAM testing to guide tuberculosis treatment among severely ill in-patients with HIV in real-world practice: a multi-center stepped wedge cluster-randomized trial from Ghana

The lateral flow urine lipoarabinomannan assay, Determine TB-LAM (Determine LAM), offers the potential for timely tuberculosis (TB) treatment among people living with HIV (PWH). In this cluster-randomized trial, Determine LAM was made available with staff training with performance feedback at three...

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Bibliographic Details
Published in:Clinical infectious diseases 2023-05
Main Authors: Åhsberg, Johanna, Puplampu, Peter, Kwashie, Augustine, Commey, Joseph Oliver, Ganu, Vincent Jessey, Omari, Michael Amo, Adusi-Poku, Yaw, Andersen, Åse Bengård, Kenu, Ernest, Lartey, Margaret, Johansen, Isik Somuncu, Bjerrum, Stephanie
Format: Article
Language:English
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Summary:The lateral flow urine lipoarabinomannan assay, Determine TB-LAM (Determine LAM), offers the potential for timely tuberculosis (TB) treatment among people living with HIV (PWH). In this cluster-randomized trial, Determine LAM was made available with staff training with performance feedback at three hospitals in Ghana. Newly admitted PWH with a positive WHO four-symptom screen for TB, severe illness, or advanced HIV were enrolled. The primary outcome was days from enrollment to TB treatment initiation. We also reported the proportion of patients with a TB diagnosis, initiating TB treatment, all-cause mortality, and Determine LAM uptake at 8 weeks. We enrolled 422 patients including 174 (41.2%) in the intervention group. The median CD4 count was 87 cells/mm3 (IQR 25-205) and 138 patients (32.7%) were on antiretroviral therapy. More patients were diagnosed with TB in the intervention group compared with the control group, 59 (34.1%; 95%CI27.1-41.7) vs 46 (18.7%; 95%CI14.0-24.1), p
ISSN:1537-6591