7th SA TB Conference 2022 Poster Presentation
Track 3: Implementation/Health systems
Authors: Lynette Duckworth; Jayandry Tasha Govender
Background
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
Implementation
TECHNICAL SUPPORT
- 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
DIRECT SERVICE DELIVERY
- 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%)
Conclusion
- 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
