7th SA TB Conference 2022 Poster Presentation

Track 3: Implementation/Health systems

Authors: Lynette Duckworth; Jayandry Tasha Govender


Identifying missing TB cases in HIV-positive clients is an ongoing challenge. As a simple point-of-care test, LF-LAM can be performed in 25 minutes using urine, a sample that is readily available. Positive results can be actioned immediately allowing rapid linkage to care and reduction in mortality for HIV/TB-coinfected patients.

Challenges of TB-HIV Co-Infection:

  • Atypical and non-specific presentation of TB disease, particularly if CD4 <200
  • Often test GeneXpert negative due to paucibacillary disease; lack of pulmonary symptoms or inability to produce sputum
  • Extrapulmonary disease is high (40-60%); with a significant proportion having disseminated TB
  • Delayed diagnosis results in a high mortality



  • Training – formal training to all facilities in the supported districts
    • 764 Healthcare workers, including 170 doctors
  • In-service Training – small group practical training
  • Ongoing mentoring in supported facilities
  • Job Aids and Algorithms – printed and distributed
  • Tool development – Development of tools to support monitoring of LF-LAM usage in facilities
  • Pharmacy support – LF-LAM stock availability and correct ordering procedures


  • Screening and testing
  • Review of TB Case ID registers in hospitals to identify admitted HIV-positive clients, with negative GeneXpert tests
  • Mentoring in the hospital setting to ensure LF-LAM is done as a point-of-care test for HIV-positive admitted clients
  • Ensure correct recording to monitor LF-LAM uptake

Results January and July 2022

Results from DOH facilities supported by THINK teams:

  • Yield: 20%
  • LF-LAM tests performed: 1696
  • Number tested positive: 347/1696 (20%)
  • Number started on TB treatment: 344/347 (99%)
  • GeneXpert tests were conducted concurrently on 1166/1696 (69%)


  • LF-LAM has been demonstrated as a simple point-of-care tool for identifying TB in HIV-positive patients
  • A high yield of 20% was achieved
  • 344 people, who would have potentially been otherwise missed, were started immediately on TB treatment between January and July 2022
  • The training and mentoring of DOH and THINK DSD staff has supported the rapid uptake of LF-LAM in 4 supported KZN districts
  • The distribution of Job Aids and the development of monitoring tools have assisted in correct patient management and monitoring of LF-LAM uptake
Tuberculosis case yield from LF-LAM: Experience from four districts in KwaZulu-Natal, South Africa