A Zimbabwean Doctors Without Borders (MSF) Nurse and Researcher, Chenai Mathabire, has been awarded an HIV/TB Research Prize by the International AIDS Society Conference on HIV Science for her research on the life-saving tuberculosis (TB) test kit.
Mathabire produced scientific evidence that showed that an easy-to-use, point-of-care TB LAM test, which quickly diagnoses TB in people living with HIV, can be rolled out as a diagnostic tool in clinics with high numbers of HIV and TB patients. Mathabire conducted the research in Malawi and Mozambique.
The test, which costs $3, offers a quick, simple and cost-effective alternative that gives on-the-spot results in 30 minutes, meaning patients can start on their treatment sooner.
“In Malawi, some HIV patients with suspected TB were waiting months for laboratory or X-ray results to come back. Clinicians don’t like to start patients on treatment based only on clinical signs and symptoms, they prefer to have a diagnostic test result,” said Mathabire.
“The TB LAM test helped them make that decision, and they felt better about starting HIV patients on TB treatment. It doesn’t replace existing tests, but adding this test helps us identify more TB cases and can improve the patients’ chances of survival,” continued Mathabire.
The test uses the HIV patient’s urine to detect LAM (Lipoarabinomanan), a protein created when TB bacteria cells break down. The lower the patients’ immunity, which is measured by numbers of CD4 T-cells, the more LAM appears in the urine and the more sensitive the test becomes. This is why the test is recommended for use in patients with CD4 cells below 100.
The MSF study found the test was well accepted by staff, easy to use, and led to better, faster results than sputum or X-ray tests. Nearly 99% of TB LAM test patients received a timely result, versus 70% with sputum and 35% with X-rays.
Despite being available since 2010, only 140,000 TB LAM tests are used each year, according to the MSF.
The MSF believes that the main barrier to wider use of the TB LAM test by national governments is that it isn’t included in country guidelines and national TB programmes are not actively pushing it.
Use of the TB LAM test has been recommended by the new WHO guidelines for advanced HIV for use in severely ill patients in hospitals but not yet in primary care, given the test’s decreased accuracy in patients with stronger immune responses.
MSF says it will use the study to advocate for health ministries in countries with high HIV TB burdens to use the TB LAM test in primary care and hospital centres, as well as include TB LAM within a diagnostic package for patients with advanced HIV.
MSF currently uses TB LAM as part of a diagnostic package in HIV projects in Democratic Republic of Congo (DRC), Guinea, Kenya, Malawi, Mozambique, Niger, Uganda and Zimbabwe.