Implementation and Operational Research: What Happens After a Negative Test for Tuberculosis? Evaluating Adherence to TB Diagnostic Algorithms in South African Primary Health Clinics

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2016 Mar 12

PMID 26966843

Citations 18

Authors

K M McCarthy

A D Grant

V Chihota

S Ginindza

L Mvusi

G J Churchyard

K L Fielding

Affiliations

Soon will be listed here.

Abstract

Introduction And Background: Diagnostic tests for tuberculosis (TB) using sputum have suboptimal sensitivity among HIV-positive persons. We assessed health care worker adherence to TB diagnostic algorithms after negative sputum test results.

Methods: The XTEND (Xpert for TB-Evaluating a New Diagnostic) trial compared outcomes among people tested for TB in primary care clinics using Xpert MTB/RIF vs. smear microscopy as the initial test. We analyzed data from XTEND participants who were HIV positive or HIV status unknown, whose initial sputum Xpert MTB/RIF or microscopy result was negative. If chest radiography, sputum culture, or hospital referral took place, the algorithm for TB diagnosis was considered followed. Analysis of intervention (Xpert MTB/RIF) effect on algorithm adherence used methods for cluster-randomized trials with small number of clusters.

Results: Among 4037 XTEND participants with initial negative test results, 2155 (53%) reported being or testing HIV positive and 540 (14%) had unknown HIV status. Among 2155 HIV-positive participants [684 (32%) male, mean age 37 years (range, 18-79 years)], there was evidence of algorithm adherence among 515 (24%). Adherence was less likely among persons tested initially with Xpert MTB/RIF vs. smear [14% (142/1031) vs. 32% (364/1122), adjusted risk ratio 0.34 (95% CI: 0.17 to 0.65)] and for participants with unknown vs. positive HIV status [59/540 (11%) vs. 507/2155 (24%)].

Conclusions: We observed poorer adherence to TB diagnostic algorithms among HIV-positive persons tested initially with Xpert MTB/RIF vs. microscopy. Poor adherence to TB diagnostic algorithms and incomplete coverage of HIV testing represents a missed opportunity to diagnose TB and HIV, and may contribute to TB mortality.

Citing Articles

A synthesis of qualitative evidence of barriers and facilitators in implementing guidelines for TB testing in healthcare settings.

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The utility of repeat Xpert MTB/RIF testing to diagnose tuberculosis in HIV-positive adults with initial negative result.

Hanifa Y, Fielding K, Chihota V, Adonis L, Charalambous S, Foster N Gates Open Res. 2023; 2:22.

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Breakthrough TB among people living with HIV on TB preventive therapy.

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The impact of HIV and tuberculosis interventions on South African adult tuberculosis trends, 1990-2019: a mathematical modeling analysis.

Kubjane M, Osman M, Boulle A, Johnson L Int J Infect Dis. 2022; 122:811-819.

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TB testing in HIV-positive patients prior to antiretroviral treatment.

Spooner E, Reddy S, Ntoyanto S, Sakadavan Y, Reddy T, Mahomed S Int J Tuberc Lung Dis. 2022; 26(3):224-231.

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