Screening for tuberculosis in the urine of people living with HIV can save lives and be profitable

Screening for tuberculosis (TB) in all hospitalized HIV patients, using urine tests, would improve life expectancy and be cost-effective in Malawi and South Africa. The findings of an international team of investigators have been published in The Lancet Global Health and could influence international guidelines for TB screening.

"Testing for tuberculosis in the urine saves lives and is an effective use of resources," says lead author Krishna Reddy, MD, MS, Division of Pulmonary Medicine and Critical Care at Mbadachusetts General Hospital ( MGH), as well as the center of evaluation of medical practice. "This has huge implications for increasing the survival of HIV-positive people in Africa and other areas where TB is common."

Tuberculosis is the leading cause of death among people living with HIV worldwide. Many cases are not accounted for by standard sputum-based test strategies, as some patients can not provide a sputum sample. A urine sample, however, can be obtained from almost all patients. Lipoarabinomannan (LAM) and Xpert testing have been shown to improve the detection of tuberculosis in some HIV-positive patients, but it was unclear whether urinary testing of all HIV-infected patients hospitalized patients would be useful and economical.

This study was conducted in conjunction with the STAMP (Rapid Tuberculosis Screening to Reduce AIDS-Related AIDS Patients in African Patients in Urine), a large-scale clinical trial for tuberculosis screening. urine in HIV-infected hospital patients and in Malawi. South Africa, the results of which were published in The lancet in July 2018. In this study, researchers used a computer simulation model of HIV and TB to match short-term clinical outcomes reported by the STAMP trial and project long-term clinical and economic outcomes. term.

The researchers found that screening all tuberculosis patients in hospital with HIV using AML and Xpert urine tests would increase life expectancy from 0.5 to 1, 2 years and would be profitable compared to the only sputum test performed in both countries. As observed in the STAMP trial, in which both tests were used to screen each participant, urinary MAMA was particularly attractive for increasing the number of TB diagnoses and reducing the number of deaths, with a cost of only 3 $ per test.

"Compared to other diagnostic strategies, urine tests are relatively easy and inexpensive and can detect cases of TB that otherwise would have been missed," said co-author Ankur Gupta-Wright , MRCP of the London School of Hygiene & Tropical Medicine. Malawi-Liverpool-Wellcome Trust Clinical Research Program, which led the STAMP clinical trial. He added: "Urinary MAMA gives a result in less than 30 minutes and can be performed at the bedside of the patient."

Given that the results of the urine tests were very useful, the investigators undertook the next step: to examine the financial implications of implementing TB screening across the country in all patients. infected with HIV and hospitalized in both countries. The evaluation included both the costs of urine tests and those of research and treatment of a larger number of TB cases. They found that over five years, the urine screening strategy would increase health care costs for these patients by $ 37 million (10.8%) in Malawi and $ 261 million (2%). 8%) in South Africa.

"Because patients are living longer, health care costs are rising, but the impact is modest – it's a wise investment," said Reddy, an badistant professor of medicine at Harvard Medical School.

The World Health Organization currently recommends the use of LAM in urine in some patients only. The authors of the study say that the results of the STAMP trial and this cost-effectiveness badysis provide evidence to extend the use of urinary MAMA to all hospitalized HIV patients, regardless of symptoms or suspicion of tuberculosis, in areas where HIV and TB are common.

###

Rochelle Walensky, MD, MPH, of the Medical Practice Evaluation Center and the Division of Infectious Diseases at MGH Hospital is the lead author of The Lancet Global Health. Other co-authors are Sydney Costantini, Amy Zheng, Liyang Yu, MS, and Kenneth Freedberg, MD, MSc, MGH Hospital Medical Practice Evaluation Center; Katherine Fielding, PhD, Elizabeth Corbett, PhD, Jurgens Peters, MSc, and Stephen Lawn, MD, London School of Hygiene & Tropical Medicine; Joep van Oosterhout, PhD, and Melanie Alufandika-Moyo, MSc, Dignitas International; Stephen Resch, PhD, Harvard T.H. Chan School of Public Health; Douglas Wilson, FCP (SA), University of KwaZulu-Natal; Robert Robert Horsburgh, MD, School of Public Health, Boston University; and Robin Wood, University of Cape Town.

The study was funded by the MR / M007375 / 1 grant from the World Health Research Council's Medical Research Program / International Development Department / Wellcome Trust for the STAMP trial; National Institutes of Health Grants K01 DA042687, R37 AI093269, R01 AI058736, P30 AI042853 and U19 AI111276; the James Maxwell Grant Prophit Scholarship of the Royal College of Physicians; Wellcome Trust Fellowship WT200901 / Z / 16 / Z and the Researchers Steve and Deborah Gorlin Award at MGH Hospital.

Mbadachusetts General Hospital, founded in 1811, is the first and largest university hospital at Harvard Medical School. The MGH Research Institute leads the country's largest hospital-based research program, with an annual research budget of more than $ 900 million, as well as major research centers on HIV / AIDS, cardiovascular research, cancer, computer and integrative biology, skin biology, genomic medicine. , medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The HGM is topping the 2015 list of health care organizations published by the Nature Index in reputable scientific journals and has won the prestigious 2015 Foster G. McGaw Award for Excellence in Service to the community. In August 2018, the MGH was again named to the board of honor of US News and World Report list of "Best Hospitals in America".

Warning: AAAS and EurekAlert! are not responsible for the accuracy of the news releases published on EurekAlert! contributing institutions or for the use of any information via the EurekAlert system.