Improved tuberculosis case finding among patients with Advanced HIV Disease in Nigeria through the deployment of a point of care tuberculosis diagnostic test

Title

Improved tuberculosis case finding among patients with Advanced HIV Disease in Nigeria through the deployment of a point of care tuberculosis diagnostic test

Presenter

Williams Eigege

Authors

W. Eigege * (1), B. LevyBraide (1), N. Otubu (1), O. Abudiore (1), O. Sowale (1), A. Inyang (1), D. Rathakrishnan (2), J. Conroy (2), I. Amamilo (2), F. Lufadeju (1), C. Amole (2), O. Wiwa (1), C. Adesigbin (3), P. Nwaokenneya (3), A. Ikpeazu (3), R. Oladele (4,5), O. Agbaji (6), S. Akanmu (4)

Institutions

(1) Clinton Health Access Initiative, HIV Access Program, Abuja, Nigeria, (2) Clinton Health Access Initiative, HIV Access Program, Boston, United States, (3) Federal Ministry of Health, National AIDS and STI Control Programme, Abuja, Nigeria, (4) Lagos University Teaching Hospital, Lagos, Nigeria, (5) Medical Mycology Association of Nigeria, Lagos, Nigeria, (6) Jos University Teaching Hospital, Jos, Nigeria

BACKGROUND: Nigeria recently rolled out a package of care (PoC) to manage Advanced HIV Disease (AHD) among people living with HIV (PLHIV). The AHD PoC recommends screening for opportunistic infections and use of tuberculosis lateral flow urine lipoarabinomannan assay (TB-LAM), a point of care test, to complement the Xpert MTB/RIF test for prompt identification of Tuberculosis (TB) in AHD patients. We documented early lessons from the deployment of TB-LAM in Nigeria.
DESCRIPTION: Facility implementation of AHD PoC commenced in February 2021 and involved 28 health facilities across 4 high-burden states (Lagos, Akwa-Ibom, Rivers and Anambra). Healthcare workers (HCWs) conducted TB-LAM tests for AHD patients regardless of TB symptoms, and those with positive results were referred for Xpert MTB/RIF, the gold standard for TB diagnosis in-country. Diagnosed TB patients were managed for TB and commenced on antiretroviral therapy after 2-weeks of TB treatment.
LESSONS LEARNED: By September 2021, 80% (1719 of 2160) of newly enrolled PLHIV with AHD received TB-LAM test and 35% (606 of 1719) tested positive. Of those positive, 70% (426 of 606) had a documented Xpert MTB/RIF result. 75% (320 of 426) of confirmed TB cases commenced treatment.
The proportion of AHD patients who received TB-LAM test increased across the quarters with 56%, 81% and 90% recorded in Q1, Q2 and Q3 2021 respectively. In Q3 2021, 78% (166 of 214) of TB-LAM positive patients received an Xpert MTB/RIF, and 55% (91 of 166) of these patients tested positive with Xpert MTB/RIF.
Some HCWs did not conduct Xpert MTB/RIF for TB-LAM positive patients without TB symptoms and also did not treat Xpert negative TB-LAM positive patients as there was no clear guidance from the TB program. Limited availability of urine sample cups in Q1 impacted TB-LAM testing. Ensuring availability of all commodities required for TB-LAM testing and enhanced collaboration between TB and HIV programs at facility and national levels will improve AHD patients' outcomes.
CONCLUSIONS: Introduction of TB-LAM test as part of the AHD PoC has improved TB case identification among PLHIV. Using these lessons, clear guidance recommending treatment for TB-LAM positive patients was developed for use across the HIV and TB programs

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