Impact of the Introduction of a Package of Care Involving Early Detection of Opportunistic Infections in People Living with HIV/AIDS: A Pan American Health Organization (PAHO) Initiative in Brazil

Pasqualotto, Alessandro C.; Sued, Omar; Reis, Nicole; Silva, Larissa  R.; Soares, Renata  B. A.; Godoy, Cassia  S. M.; Melo, Marineide  G.; Hatem, Nayla  A.; Razzolini, Bruna  Regis; Noal, Andressa; Vieceli, Tarsila; Falci, Diego  R.; Perez, Freddy

doi:10.2139/ssrn.4794464

2024

DOI: 10.2139/ssrn.4794464

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Impact of the Introduction of a Package of Care Involving Early Detection of Opportunistic Infections in People Living with HIV/AIDS: A Pan American Health Organization (PAHO) Initiative in Brazil

Alessandro C. Pasqualotto,

Omar Sued,

Nicole Reis

et al.

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2024

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Performance of urine Xpert MTB/RIF ultra in a tuberculosis screening strategy in hospitalized patients with advanced HIV disease: Results from an implementation initiative in Brazil

Falci,

Pasqualotto,

Vieceli

et al. 2024

HIV Medicine

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ObjectivesTo evaluate the performance of Xpert MTB/RIF Ultra testing in urine samples as part of a TB screening strategy in patients with advanced HIV disease (AHD).MethodsWe conducted a multicentre prospective cohort study across three HIV reference hospitals in Brazil, between January and December 2023. The study included adult hospitalized patients with AHD, defined by a CD4 count of <200 cells/μL in the last 3 months or clinical presentation suggestive of opportunistic infection, without effective antiretroviral treatment. Participants underwent systematic tuberculosis (TB) screening using urine Xpert MTB/RIF Ultra and TB lipoarabinomannan (TB‐LAM) tests. The diagnosis performance of urine Xpert MTB/RIF Ultra was assessed including sensitivity, specificity, and positive and negative predictive values. Disease characterization was based on the Global Tuberculosis Dictionary. Survival at 30 and 90 days was also evaluated.ResultsUrine molecular testing was performed on 133 patients. Xpert MTB/RIF Ultra showed a sensitivity of 20.7% in bacteriologically confirmed TB cases and 21.2% in cases that included both clinically diagnosed and bacteriologically confirmed TB. The addition of urine Xpert MTB/RIF Ultra to TB‐LAM led to the detection of three additional cases, representing a 6.3% increase from the 48 cases detected by TB‐LAM. Xpert MTB/RIF Ultra had a specificity of 96.9% and no rifampicine resistance mutations were detected. Overall mortality was 16/133 (12.0%) at 30 days and 25/127 (19.7%) at 90 days.ConclusionsThere was a high overlap between urine TB‐LAM and Xpert MTB/RIF Ultra results, with the addition of Xpert MTB/RIF providing limited additional benefit for TB screening in patients with AHD.

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Performance of urine Xpert MTB/RIF ultra in a tuberculosis screening strategy in hospitalized patients with advanced HIV disease: Results from an implementation initiative in Brazil

Falci,

Pasqualotto,

Vieceli

et al. 2024

HIV Medicine

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Impact of the Introduction of a Package of Care Involving Early Detection of Opportunistic Infections in People Living with HIV/AIDS: A Pan American Health Organization (PAHO) Initiative in Brazil

Cited by 1 publication

References 12 publications

Performance of urine Xpert MTB/RIF ultra in a tuberculosis screening strategy in hospitalized patients with advanced HIV disease: Results from an implementation initiative in Brazil

Performance of urine Xpert MTB/RIF ultra in a tuberculosis screening strategy in hospitalized patients with advanced HIV disease: Results from an implementation initiative in Brazil

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