Xpert testing to find TB in people with advanced HIV at diagnosis saves lives, study finds

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In sub-Saharan Africa where the odds of dying within a year of starting treatment for HIV can still hover close to one-in-10, diagnosing and treating TB — a curable disease that remains the leading cause of death for people with the virus — at the point of HIV testing offers a life-saving opportunity to improve patients’ chances. That makes accurate, point of care testing all the more urgently needed in places like in rural Malawi, where an X-ray to identify TB, and treatment  for the disease based on symptoms, can be out of reach during the wait for laboratory test results.

A study reported in Clinical Infectious Diseases this week confirms that patients newly diagnosed with HIV who were screened for TB with Xpert technology had higher survival rates in the year that followed than those screened with a point-of-care test using flourescent light-emitting microscopy. The findings of reduced mortality rates from all causes were particularly significant, the authors write, among younger patients, men, and those with advanced HIV. The authors note that because causes of death could not be reliably ascertained, the findings do not reflect tuberculosis deaths only.

The authors, led by Lucky Ngwira of Malawi Liverpool Wellcome Trust, also note that due to fewer new HIV diagnoses across the 12 health clinics included in the study, the study population was smaller than planned. And they caution that using Xpert technology in a resource-limited rural environment requires establishing reliable electricity through solar power, continuous training, and investments in equipment and other supplies.

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