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- Title
Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa.
- Authors
Bassett, Ingrid V.; Forman, Leah S.; Govere, Sabina; Thulare, Hilary; Frank, Simone C.; Mhlongo, Bright; Losina, Elena
- Abstract
<bold>Background: </bold>Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.<bold>Trial Registration: </bold>This study was registered on November 21, 2014 at ClinicalTrials.gov ( NCT02298309 ).
- Subjects
SOUTH Africa; HIV; MYCOBACTERIUM tuberculosis; WEIGHT loss; SYMPTOMS; TREATMENT effectiveness; SPUTUM; DIAGNOSIS of HIV infections; TUBERCULOSIS complications; TUBERCULOSIS diagnosis; HIV infection complications; COMPARATIVE studies; RESEARCH methodology; MEDICAL cooperation; MEDICAL screening; MOLECULAR diagnosis; RESEARCH; RESEARCH funding; STATISTICAL sampling; SERODIAGNOSIS; PILOT projects; EVALUATION research; RANDOMIZED controlled trials; MOBILE hospitals; DISEASE complications; MIXED infections; DIAGNOSIS
- Publication
BMC Infectious Diseases, 2019, Vol 19, Issue 1, p1
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-019-3738-4