Tuberculosis screening among HIV-positive inpatients: a systematic review and individual participant data meta-analysis

Dhana, Ashar; Hamada, Yohhei; Kengne, André Pascal; Kerkhoff, Andrew D.; Rangaka, Molebogeng X; Kredo, Tamara; Baddeley, Annabel; Miller, Cecily; Gupta-Wright, Ankur; Fielding, Katherine; Wood, Robin; Huerga, Helena; Rücker, Sekai Chenai Mathabire; Heidebrecht, Christine; Wilson, Douglas P.; Bjerrum, Stephanie; Johansen, Işik Somuncu; Thit, Swe Swe; Kyi, Mar Mar; Hanson, Josh; Barr, David; Meintjes, Graeme; Maartens, Gary

doi:10.1016/s2352-3018(22)00002-9

Cited by 26 publications

(16 citation statements)

References 36 publications

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“… 2 However, both the sensitivity and specificity by our study were comparable to those reported by a recent meta-analysis among HIV-positive inpatients. 26 Our study reported a slightly higher specificity than that reported by the meta-analysis when W4SS and CRP were used in parallel. The overall sensitivity and specificity of W4SS and six-symptom screening were similar to those by a previous study conducted in the Zambian setting 27 and by WHO.…”

Section: Discussioncontrasting

confidence: 58%

Sensitivity and specificity of CRP and symptom screening as tuberculosis screening tools among HIV-positive and negative outpatients at a primary healthcare facility in Lusaka, Zambia: a prospective cross-sectional study

et al. 2023

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ObjectivesTo evaluate the performance of point-of-care C-reactive protein (CRP) as a screening tool for tuberculosis (TB) using a threshold of 10 mg/L in both people living with HIV (PLHIV) and HIV-negative individuals and compare it to symptom screening using a composite reference for bacteriological confirmation of TB.MethodsProspective cross-sectional study.SettingA primary healthcare facility in Lusaka, Zambia.ParticipantsConsecutive adults (≥18 years) presenting for routine outpatient healthcare were enrolled. Of the 816 individuals approached to participate in the study, 804 eligible consenting adults were enrolled into the study, of which 783 were included in the analysis.Primary outcome measuresSensitivity, specificity, positive predictive value and negative predictive value (NPV) of CRP and symptom screening.ResultsOverall, sensitivity of WHO-recommended four-symptom screen (W4SS) and CRP were 87.2% (80.0–92.5) and 86.6% (79.6–91.8) while specificity was 30.3% (26.7–34.1) and 34.8% (31.2–38.6), respectively. Among PLHIV, sensitivity of W4SS and CRP was 92.2% (81.1–97.8) and 94.8% (85.6–98.9) while specificity was 37.0% (31.3–43.0) and 27.5% (22.4–33.1), respectively. Among those with CD4≥350, the NPV for CRP was 100% (92.9–100). In the HIV negative, sensitivity of W4SS and CRP was 83.8% (73.4–91.3) and 80.3% (69.5–88.5) while specificity was 25.4% (20.9–30.2) and 40.5% (35.3–45.6), respectively. Parallel use of CRP and W4SS yielded a sensitivity and NPV of 100% (93.8–100) and 100% (91.6–100) among PLHIV and 93.3% (85.1–97.8) and 90.0% (78.2–96.7) among the HIV negatives, respectively.ConclusionSensitivity and specificity of CRP were similar to symptom screening in HIV-positive outpatients. Independent use of CRP offered limited additional benefit in the HIV negative. CRP can independently accurately rule out TB in PLHIV with CD4≥350. Parallel use of CRP and W4SS improves sensitivity irrespective of HIV status and can accurately rule out TB in PLHIV, irrespective of CD4 count.

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Section: Discussioncontrasting

confidence: 58%

Sensitivity and specificity of CRP and symptom screening as tuberculosis screening tools among HIV-positive and negative outpatients at a primary healthcare facility in Lusaka, Zambia: a prospective cross-sectional study

et al. 2023

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“…FujiLAM is expected to produce fewer cross-reactions with non-tuberculous mycobacteria than AlereLAM due to highly specific antibodies. 18 , 20 , 27 We found most false positive FujiLAM results were weakly positive and occurred in specific lot numbers. One hypothesis is that some false positive results could also be due to cross-reactions with other pathogens producing weakly positive results.…”

Section: Discussionmentioning

confidence: 69%

Novel FujiLAM assay to detect tuberculosis in HIV-positive ambulatory patients in four African countries: a diagnostic accuracy study

Huerga¹,

Bastard²,

Lubega

et al. 2023

The Lancet Global Health

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“…Disagreements between authors were resolved by discussion. We used similar methods to our recent systematic review that contributed to the 2021 WHO tuberculosis screening guidelines; 13,16,19 LF-LAM analyses were not pre-specified in our protocol. Our initial systematic review was registered on PROSPERO (CRD42020155895).…”

Section: Methodsmentioning

confidence: 99%

“…The W4SS, which was developed among ambulatory PLHIV, 15 has low specificity for diagnosis of tuberculosis in inpatients. 16 CD4 cell count may also have low specificity, since inpatients typically have advanced immunodeficiency. It is also often not rapidly available.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of WHO screening criteria to guide lateral-flow lipoarabinomannan testing among HIV-positive inpatients: A systematic review and individual participant data meta-analysis

Dhana

Hamada

Kengne

et al. 2022

Journal of Infection

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Tuberculosis screening among HIV-positive inpatients: a systematic review and individual participant data meta-analysis

Cited by 26 publications

References 36 publications

Sensitivity and specificity of CRP and symptom screening as tuberculosis screening tools among HIV-positive and negative outpatients at a primary healthcare facility in Lusaka, Zambia: a prospective cross-sectional study

Sensitivity and specificity of CRP and symptom screening as tuberculosis screening tools among HIV-positive and negative outpatients at a primary healthcare facility in Lusaka, Zambia: a prospective cross-sectional study

Novel FujiLAM assay to detect tuberculosis in HIV-positive ambulatory patients in four African countries: a diagnostic accuracy study

Diagnostic accuracy of WHO screening criteria to guide lateral-flow lipoarabinomannan testing among HIV-positive inpatients: A systematic review and individual participant data meta-analysis

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