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Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpert MTB/RIF era: a cohort study

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dc.contributor.author Hermans, S. M. en_US
dc.contributor.author Babirye, J. A. en_US
dc.contributor.author Mbabazi, O. en_US
dc.contributor.author Kakooza, F. en_US
dc.contributor.author Colebunders, R. en_US
dc.contributor.author Castelnuovo, B. en_US
dc.contributor.author Sekaggya-Wiltshire, C. en_US
dc.contributor.author Parkes-Ratanshi, R. en_US
dc.contributor.author Manabe, Y. C. en_US
dc.date.accessioned 2017-12-18T12:55:42Z
dc.date.available 2017-12-18T12:55:42Z
dc.date.issued 2017 en_US
dc.identifier.issn 1471-2334 en_US
dc.identifier.doi http://dx.doi.org/10.1186/s12879-017-2534-2 en_US
dc.identifier.other http://lib.itg.be/pdf/itg/2017/2017bidi0433.pdf en_US
dc.identifier.other ITG-C5X; DCS; U-HIVCLI; JIF; OAJ; DOI; PDF; PMC; Abstract; DSPACE64 en_US
dc.identifier.uri http://hdl.handle.net/10390/9533
dc.description.abstract BACKGROUND: The Xpert MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). METHODS: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda. Prior to testing clinicians were asked to decide whether they would treat empirically prior to Xpert result; actual treatment was decided upon receipt of the XP result. We compared empirical and XP-informed treatment decisions and all-cause mortality in the first year. RESULTS: Of 411 smear-negative presumptive TB patients, 175 (43%) received an XP; their baseline characteristics did not differ. XP positivity was similar in patients with a pre-XP empirical diagnosis and those without (9/29 [17%] versus 14/142 [10%], P = 0.23). Despite XP testing high levels of empirical treatment prevailed (18%), although XP results did change who ultimately was treated for TB. When adjusted for CD4 count, empirical treatment was not associated with higher mortality compared to no or microbiologically confirmed treatment. CONCLUSIONS: XP usage was lower than expected. The lower sensitivity of XP in smear-negative HIV-positive patients led experienced clinicians to use XP as a "rule-in" rather than "rule-out" test, with the majority of patients still treated empirically. en_US
dc.language English en_US
dc.relation.uri http://www.ncbi.nlm.nih.gov/pubmed/28622763 en_US
dc.subject Tuberculosis en_US
dc.subject Bacterial diseases en_US
dc.subject HIV en_US
dc.subject Viral diseases en_US
dc.subject Diagnostic tests en_US
dc.subject Treatment en_US
dc.subject Mortality en_US
dc.subject Uganda en_US
dc.subject Africa-East en_US
dc.title Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpert MTB/RIF era: a cohort study en_US
dc.type Article-E en_US
dc.citation.issue 1 en_US
dc.citation.jtitle BMC Infectious Diseases en_US
dc.citation.volume 17 en_US
dc.citation.pages 433 en_US
dc.citation.abbreviation BMC Infect Dis en_US


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