In Africa, nearly 40% of all adult deaths related to HIV or AIDS are due to tuberculosis, but almost half of the TB cases remain undiagnosed and untreated before death.

Study published in The Lancet on 9 March 2016

The authors of the study, which was conducted in 10 hospitals in sub-Saharan Africa, say that, if implemented more widely, this low-cost intervention could save thousands of lives per year.

“This is the first trial of any diagnostic test for TB to show a reduction in the number of deaths. The reduction in mortality is likely to be because urine-testing, in conjunction with routine testing, resulted in a greater proportion of patients starting TB treatment early,” explains senior author and project supervisor Professor Keertan Dheda from the University of Cape Town in South Africa.

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TB leading cause of death in HIV sufferers

Tuberculosis is the leading cause of death in people with HIV in low and middle income countries and hospitals are often overwhelmed with HIV-positive individuals who have suspected TB. Diagnosis of TB usually includes taking a chest X-ray and microbiological examination of sputum (mucous that has been coughed-up).

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However, for severely ill patients with TB and HIV, it can be hard to produce sputum and alternative approaches are often unavailable. The urine-test provides a result in 25 minutes and each test costs about US$2.66 (R40,00).

In this study, the research team randomly allocated 2 528 patients with HIV from ten hospitals in four countries in sub-Saharan Africa (four in South Africa, two in Tanzania, two in Zambia, and two in Zimbabwe) to receive either routine testing as well as the urine-test or routine testing alone.

Absolute reduction of 4%

“The absolute reduction in mortality was small at 4%, but with 300 000 patients with HIV dying from TB in Africa every year, implementing this low cost, rapid, bedside test could potentially save thousands of lives annually,” said Dheda.

Dr Andrew Kerkhoff, University of California San Francisco School of Medicine, San Francisco, USA, writes in a linked Comment: “We strongly advocate that the urine-test be implemented by national TB programmes in sub-Saharan Africa to reduce AIDS-related inpatient deaths.”

For full Article and Comment see: http://press.thelancet.com/TBtesting.pdf

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