Abstract

BackgroundCommunity-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion.MethodsWe 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.Results4815 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.ConclusionGeneXpert 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 registrationThis study was registered on November 21, 2014 at ClinicalTrials.gov (NCT02298309).

Highlights

  • Community-based GeneXpert Mycobacterium tuberculosis (MTB)/Resistance to rifampin (RIF) testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion

  • Building on the Bassett et al BMC Infectious Diseases (2019) 19:110 theoretical foundation of the Test and Treat approach for Human immunodeficiency virus (HIV) [8,9,10], we conducted a pilot randomized controlled trial to evaluate the yield of GeneXpert MTB/RIF on a mobile HIV testing unit operating in community venues in Umlazi Township, Durban

  • Our objective was to establish the feasibility of a program that: 1) uses GeneXpert screening on a mobile testing unit, and 2) shortens time to TB treatment initiation compared to clinic-based referral for patients to be evaluated for TB, with the goal of increasing TB treatment completion rates

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Summary

Introduction

Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. We assessed integrating GeneXpert MTB/RIF and HIV screening, maximizing the impact of mobile units, which typically refer patients with suspected TB to local clinics for evaluation and treatment [11, 12]. Our objective was to establish the feasibility of a program that: 1) uses GeneXpert screening on a mobile testing unit, and 2) shortens time to TB treatment initiation compared to clinic-based referral for patients to be evaluated for TB, with the goal of increasing TB treatment completion rates

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