@article{fdi:010069307,
  title = {{I}ncremental yield of including determine-{TB} {LAM} assay in diagnostic algorithms for hospitalized and ambulatory {HIV}-positive patients in {K}enya},
  author = {{H}uerga, {H}. and {F}erlazzo, {G}. and {B}evilacqua, {P}. and {K}irubi, {B}. and {A}rdizzoni, {E}. and {W}anjala, {S}. and {S}itienei, {J}. and {B}onnet, {M}aryline},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {D}etermine-{TB} {LAM} assay is a urine point-of-care test useful for {TB} diagnosis in {HIV}-positive patients. {W}e assessed the incremental diagnostic yield of adding {LAM} to algorithms based on clinical signs, sputum smear-microscopy, chest {X}-ray and {X}pert {MTB}/{RIF} in {HIV}-positive patients with symptoms of pulmonary {TB} ({PTB}). {M}ethods {P}rospective observational cohort of ambulatory (either severely ill or {CD}4< 200cells/mu l or with {B}ody {M}ass {I}ndex<17{K}g/m(2)) and hospitalized symptomatic {HIV}-positive adults in {K}enya. {I}ncremental diagnostic yield of adding {LAM} was the difference in the proportion of confirmed {TB} patients (positive {X}pert or {MTB} culture) diagnosed by the algorithm with {LAM} compared to the algorithm without {LAM}. {T}he multivariable mortality model was adjusted for age, sex, clinical severity, {BMI}, {CD}4, {ART} initiation, {LAM} result and {TB} confirmation. {R}esults {A}mong 474 patients included, 44.1% were severely ill, 69.6% had {CD}4< 200cells/mu l, 59.9% had initiated {ART}, 23.2% could not produce sputum. {LAM}, smear-microscopy, {X}pert and culture in sputum were positive in 39.0% (185/474), 21.6% (76/352), 29.1% (102/350) and 39.7% (92/232) of the patients tested, respectively. {O}f 156 patients with confirmed {TB}, 65.4% were {LAM} positive. {O}f those classified as non-{TB}, 84.0% were {LAM} negative. {A}dding {LAM} increased the diagnostic yield of the algorithms by 36.6%, from 47.4% (95% {CI}: 39.4- 55.6) to 84.0% (95% {CI}: 77.3-89.4%), when using clinical signs and {X}-ray; by 19.9%, from 62.2% (95% {CI}: 54.1-69.8) to 82.1% (95% {CI}: 75.1-87.7), when using clinical signs and microscopy; and by 13.4%, from 74.4% (95% {CI}: 66.8-81.0) to 87.8% (95% {CI}: 81.6-92.5), when using clinical signs and {X}pert. {LAM} positive patients had an increased risk of 2-months mortality (a{OR}: 2.7; 95% {CI}: 1.5-4.9). {C}onclusion {LAM} should be included in {TB} diagnostic algorithms in parallel to microscopy or {X}pert request for {HIV}-positive patients either ambulatory (severely ill or {CD}4<200cells/mu l) or hospitalized. {LAM} allows same day treatment initiation in patients at higher risk of death and in those not able to produce sputum.},
  keywords = {{KENYA}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {12},
  numero = {1},
  pages = {e0170976 [15 p.]},
  ISSN = {1932-6203},
  year = {2017},
  DOI = {10.1371/journal.pone.0170976},
  URL = {https://www.documentation.ird.fr/hor/fdi:010069307},
}