Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa
Abstract Background Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. Methods We conducted a pilot randomized trial to evaluate the impact of GeneXpert screening on a mobile HIV testing unit. Adults (≥18y)...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-019-3738-4 |
| _version_ | 1819079742511382528 |
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| author | Ingrid V. Bassett Leah S. Forman Sabina Govere Hilary Thulare Simone C. Frank Bright Mhlongo Elena Losina |
| author_facet | Ingrid V. Bassett Leah S. Forman Sabina Govere Hilary Thulare Simone C. Frank Bright Mhlongo Elena Losina |
| author_sort | Ingrid V. Bassett |
| collection | DOAJ |
| description | Abstract Background Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. 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 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 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 This study was registered on November 21, 2014 at ClinicalTrials.gov (NCT02298309). |
| first_indexed | 2024-12-21T19:33:49Z |
| format | Article |
| id | doaj.art-bf911391d1b74e53860204432bcd5faa |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-21T19:33:49Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-bf911391d1b74e53860204432bcd5faa2022-12-21T18:52:39ZengBMCBMC Infectious Diseases1471-23342019-02-011911710.1186/s12879-019-3738-4Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South AfricaIngrid V. Bassett0Leah S. Forman1Sabina Govere2Hilary Thulare3Simone C. Frank4Bright Mhlongo5Elena Losina6Division of Infectious Disease, Massachusetts General HospitalData Coordinating Center, Boston University School of Public HealthAIDS Healthcare FoundationAIDS Healthcare FoundationMedical Practice Evaluation Center, Department of Medicine, Massachusetts General HospitalAIDS Healthcare FoundationMedical Practice Evaluation Center, Department of Medicine, Massachusetts General HospitalAbstract Background Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. 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 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 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 This study was registered on November 21, 2014 at ClinicalTrials.gov (NCT02298309).http://link.springer.com/article/10.1186/s12879-019-3738-4TuberculosisTest & TreatGeneXpert MTB/RIFCommunity-based screening |
| spellingShingle | Ingrid V. Bassett Leah S. Forman Sabina Govere Hilary Thulare Simone C. Frank Bright Mhlongo Elena Losina Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa BMC Infectious Diseases Tuberculosis Test & Treat GeneXpert MTB/RIF Community-based screening |
| title | Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa |
| title_full | Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa |
| title_fullStr | Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa |
| title_full_unstemmed | Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa |
| title_short | Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa |
| title_sort | test and treat tb a pilot trial of genexpert mtb rif screening on a mobile hiv testing unit in south africa |
| topic | Tuberculosis Test & Treat GeneXpert MTB/RIF Community-based screening |
| url | http://link.springer.com/article/10.1186/s12879-019-3738-4 |
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