The diagnostic accuracy of urine lipoarabinomannan test for tuberculosis screening in a South African correctional facility.

Yasmeen Hanifa,Katherine L Fielding,Lilanganee Telisinghe,Alison D Grant,Justin L Malden,Salome Charalambous,Gavin J Churchyard,Delia Goletti

doi:10.1371/journal.pone.0127956

Abstract

BackgroundWe evaluated the diagnostic accuracy of the urine lipoarabinomannan (LAM) antigen detection assay (Clearview TB-ELISA) to screen for tuberculosis in a South African correctional facility.MethodsBetween September 2009 and October 2010, male offenders were screened for tuberculosis (symptoms, chest radiograph, two spot sputum specimens for microscopy and culture), and urine tested for LAM. Sensitivity, specificity and predictive values of LAM were calculated using definite and probable tuberculosis combined as our gold standard.Findings33/871 (3.8%) participants (26% HIV-positive) had tuberculosis. Amongst HIV-positive vs. HIV-negative offenders the sensitivity and specificity of LAM was 7.1% vs. 0% and 98.5% vs. 99.8% respectively.ConclusionUrine LAM ELISA has inadequate sensitivity for TB screening in this population.

Highlights

Incarcerated populations worldwide suffer disproportionately high risk of both tuberculosis (TB) [1] and HIV infection,[2] a potent risk factor for TB
Urine LAM Test for TB in a Correctional Facility represent the official views of CDC
Our study has shown that the sensitivity of Clearview TB-ELISA is too low to be useful for the general screening of offenders in this correctional facility, of whom the majority are HIV-negative

Summary

Introduction

Incarcerated populations worldwide suffer disproportionately high risk of both tuberculosis (TB) [1] and HIV infection,[2] a potent risk factor for TB. In response to the burden of PLOS ONE | DOI:10.1371/journal.pone.0127956. Urine LAM Test for TB in a Correctional Facility represent the official views of CDC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We evaluated the diagnostic accuracy of the urine lipoarabinomannan (LAM) antigen detection assay (Clearview TB-ELISA) to screen for tuberculosis in a South African correctional facility

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Conclusion