Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa.
Adolescent
Adult
Coinfection
/ complications
Female
HIV
HIV Infections
/ complications
Humans
Male
Mass Screening
/ methods
Middle Aged
Mobile Health Units
Molecular Diagnostic Techniques
Mycobacterium tuberculosis
/ genetics
Pilot Projects
Sensitivity and Specificity
Serologic Tests
South Africa
Tuberculosis
/ complications
Young Adult
Community-based screening
GeneXpert MTB/RIF
Test & Treat
Tuberculosis
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
04 Feb 2019
04 Feb 2019
Historique:
received:
18
01
2018
accepted:
23
01
2019
entrez:
6
2
2019
pubmed:
6
2
2019
medline:
14
3
2019
Statut:
epublish
Résumé
Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. 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. 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. 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. This study was registered on November 21, 2014 at ClinicalTrials.gov ( NCT02298309 ).
Sections du résumé
BACKGROUND
BACKGROUND
Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion.
METHODS
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
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
CONCLUSIONS
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
BACKGROUND
This study was registered on November 21, 2014 at ClinicalTrials.gov ( NCT02298309 ).
Identifiants
pubmed: 30717693
doi: 10.1186/s12879-019-3738-4
pii: 10.1186/s12879-019-3738-4
pmc: PMC6360783
doi:
Banques de données
ClinicalTrials.gov
['NCT02298309']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
110Subventions
Organisme : NIAID NIH HHS
ID : R21 AI110264
Pays : United States
Organisme : National Institute of Allergy and Infectious Diseases
ID : R21 AI110264-01A1
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