Single-sputum, rapid TB diagnosis feasible in high-burden settings

A same-day, streamlined strategy for the diagnosis of tuberculosis, requiring a single sputum sample, proved accurate and feasible in a setting where the disease is endemic, according to data presented at the American Thoracic Society 2016 International Conference.

“Clinicians in Uganda can see 50 to 100 patients a day, so they often can’t focus on one disease,” Priya B. Shete, MD, lead author and clinical instructor at the University of California, San Francisco, said in a press release. “We identified people at each clinic, however, who could focus on TB and worked with the clinic to improve the training of all clinicians who might see TB patients. The results are promising, but there is more work to be done.”

Shete and colleagues developed the “SIngle-saMPLE” (SIMPLE) TB diagnosis approach, which includes a single-sample LED fluorescence microscopy, with analysis and reporting of two smear results from the initial specimen within 2 hours; and daily transport of smear-negative sputum samples to GeneXpert MTB/RIF testing sites.

To test the feasibility of the strategy in a country where TB is endemic, and its success at increasing the number of patients tested and treated for the disease, the researchers conducted a single-arm interventional pilot study at four community health centers in rural Uganda. Using the data from TB laboratory and treatment registers, the researchers analyzed process measures that reflected implementation of each treatment component and diagnosis outcomes.

According to the researchers, 12% of the 822 patients referred for TB testing were diagnosed with TB. Two smears from the initial spot specimen were analyzed and reported on the same day for 95% of patients. Of the 71 smear-positive patients identified from the first sample, 44% started treatment on the same day, while 16% started treatment on the next day. Seventeen percent did not start treatment. In addition, sputum was transported to an Xpert testing site within 1 business day of the initial visit for 95% of the 706 total patients with negative smear results from the first sample. Xpert results were positive for TB in 27 smear-negative patients, of whom 67% started treatment. – by Jason Laday

Disclosure: Healio Family Medicine could not confirm the researchers’ relevant financial disclosures

Reference:

Shete PB, et al. Feasibility of a streamlined Single-saMPLE (SIMPLE) TB diagnosis and treatment initiation strategy in Uganda. Presented at: American Thoracic Society International Conference, May 13 to 18, 2016; San Francisco.