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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Point-of-care c-reactive protein testing to facilitate implementation of isoniazid preventive therapy for people living with HIV
Journal of Acquired Immune Deficiency Syndromes, Volume 65, No. 5, Year 2014
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Description
Background: Symptom-based tuberculosis screening identifies less than one-third of eligible HIV-infected patients as candidates for isoniazid preventive therapy (IPT). We evaluated whether testing for C-reactive protein (CRP) improves patient selection for IPT. Methods: We measured CRP levels (normal >10 mg/L) using a point-of-care (POC) assay on stored serum samples from HIVinfected Ugandan adults initiating antiretroviral therapy. We assessed diagnostic accuracy in reference to baseline tuberculosis status adjudicated by an expert committee and calculated net reclassification improvement to quantify the incremental discriminatory benefit of POC-CRP in determining IPT eligibility compared to the World Health Organization (WHO) symptom screen. Results: Of 201 patients (median CD4 cell count, 137 cells/mL; interquartile range, 83-206), 5 (2.5%) had tuberculosis. Compared to the WHO symptom screen, POC-CRP had similar sensitivity (100% vs. 80%, P = 0.30) but greater specificity (21% vs. 87%, P > 0.0001) for tuberculosis. If based on the WHO symptom screen, no patients with tuberculosis but only 42 of 196 patients without tuberculosis would have been considered IPT eligible. If POC-CRP were used instead, 1 patient with tuberculosis (reclassification of cases, 220%; P = 0.32) and 129 patients without tuberculosis (reclassification of noncases, +66%; P > 0.001) would have been reclassified as IPT eligible, a net reclassification improvement of 46% (P = 0.03). In addition, POC-CRP testing would have reduced the proportion of patients without active tuberculosis requiring confirmatory tuberculosis testing (87% vs. 21%, P > 0.0001). Conclusions: POC-CRP testing increased more than 4-fold the proportion of HIV-infected adults immediately identified as IPT eligible and decreased the proportion of patients requiring referral for further tuberculosis diagnostic testing. POC-CRP testing could substantially improve implementation of tuberculosis screening guidelines. © 2013 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Yoon, Christina
United States, San Francisco
San Francisco General Hospital and Trauma Center
Davis, J. Lucian
United States, San Francisco
San Francisco General Hospital and Trauma Center
United States, Oakland
Curry International Tuberculosis Center
Huang, Laurence
United States, San Francisco
San Francisco General Hospital and Trauma Center
United States, San Francisco
Ucsf School of Medicine
Muzoora, Conrad K.
Uganda, Mbarara
Mbarara University of Science and Technology
Byakwaga, Helen
Uganda, Mbarara
Mbarara University of Science and Technology
United States, San Francisco
University of California, San Francisco
Scibetta, Colin
United States, San Francisco
University of California, San Francisco
Bangsberg, David R.
Uganda, Mbarara
Mbarara University of Science and Technology
United States, Boston
Massachusetts General Hospital
United States, Cambridge
Massachusetts Institute of Technology
Nahid, Payam
United States, San Francisco
San Francisco General Hospital and Trauma Center
Semitala, Fred Collins
Uganda, Kampala
Makerere University
Hunt, Peter W.
United States, Oakland
Curry International Tuberculosis Center
Martin, Jeffrey N.
United States, San Francisco
University of California, San Francisco
Cattamanchi, Adithya
United States, San Francisco
San Francisco General Hospital and Trauma Center
United States, Oakland
Curry International Tuberculosis Center
Statistics
Citations: 12
Authors: 12
Affiliations: 8
Identifiers
Doi:
10.1097/QAI.0000000000000085
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases