Integration of TB-LAM and Xpert MTB/RIF (Xpert) testing to improve TB case detection and shorten time to treatment initiation among People Living with HIV (PLHIV) in Harare City, Zimbabwe


BACKGROUND: The Abbott Determine TB LAM Ag (TB-LAM) assay is a urine-based point of care diagnostic test. In October 2020 the Zimbabwe Ministry of Health and Child Care (MOHCC) introduced TB-LAM test for concurrent use with Xpert among asymptomatic PLHIV with advanced disease (CD4<200cells/mL or stage 3 or 4 disease) and symptomatic PHLIV regardless of CD4 cell count or stage of disease at selected high-volume sites. We describe TB case detection, time-to-treatment before and during implementation of TB-LAM testing and acceptability and value of TB-LAM testing at 2 sites in Harare.
DESCRIPTION: Prior to implementing TB-LAM testing, we conducted on the job training for laboratory technicians and sensitized clinicians on identification of eligible clients for testing, sample collection and client management. We reviewed TB program records from October 2020 to September 2021 for two high-volume sites in Harare. We abstracted data from MoHCC registers and patient files using Excel. Health workers were interviewed to determine acceptability and ease of administration of the test.
LESSONS LEARNED: Health workers described TB-LAM as acceptable, simple to administer and shortens results turnaround time. Prior to LAM implementation (duration 8 months),161 symptomatic clients were tested using Xpert and 12% (20) were positive. Post implementation (duration 4 months), 82 clients were tested with TB-LAM and 22% (18) were positive. In the absence of TB-LAM testing 15 cases of asymptomatic TB would have remained undiagnosed among 72 PLHIV who were considered negative based on question-based symptom screening alone. Before implementation of TB-LAM testing median time from diagnosis to initiation on treatment was 2 days (IQR:1-6) and during implementation median time was 1 day (IQR:1-2).

CONCLUSIONS: Our experience demonstrates TB-LAM testing as an acceptable and simple tool to integrate into routine HIV care. Scale-up of TB-LAM can improve TB diagnosis among PLHIV co-infected with TB and may facilitate timely treatment initiation.