A quicker, simpler test for tuberculosis (TB) in people living with HIV is not being used widely enough in South Africa, despite new evidence of its benefits, according to international humanitarian organisation Doctors Without Borders (MSF).
The TB LAM test can quickly diagnose the disease in HIV patients – providing a result in as fast as 33 minutes, compared to conventional tests which can take up to two days. This was revealed on Wednesday at the 9th International AIDS Society (IAS) Conference on HIV Science taking place in Paris this week.
It is effective for patients with CD4 counts (the measure of a person’s immunity) of 200 and below, and uses urine instead of sputum to detect TB bacteria. It is only effective in this group because people who are very sick excrete a high amount of bacteria in their urine – enough for the test to detect. At only $3 (R39) per test it is also an affordable option and does not require a laboratory or special expertise and can be performed by nurses and even trained lay people.
“The TB LAM test has advantages over sputum tests for patients with late stage HIV who don’t present with the usual signs of TB and usually find it difficult to produce sputum,” MSF’s Dr Amir Shroufi told Health-e News. “There have been concerns over its accuracy but for patients with severe immunosuppression (very weak immune systems), our experience plus a rapidly evolving evidence base shows that this is a useful test that can help clinicians make quick decisions to start advanced HIV patients on treatment, when any delays have serious consequences.”
Unlike with sputum tests, the TB LAM test can provide results in under an hour and patients can be started on treatment the very same day.
But he said South Africa has been slow to act on this evidence and scale-up its use.
Most deaths in people living with HIV in South Africa are caused by TB.
Shroufi said researchers in Stokholm are working on a more sensitive version of the test so it can be used for all patients – regardless of their health status.
Deputy Director General at the Department of Health (DoH) Dr Yogan Pillay said that the reason for the delay in scale-up is that the DoH had to develop an algorithm for its use and pilot it before it could advise provinces on how to implement it.
LAM is in
“We had a consultation about the algorithm about two weeks ago and we have adopted it for use across the country. So LAM is in, and its currently being scaled up. We just need to get the traction of the hospital CEOs and the clinicians to start using it,” he said.
Sekai Chenai Mathabire-Rucker, a Zimbabwean researcher who won an award for her research on the TB LAM test in Paris this week, said that the test has significant advantages for very vulnerable patients.
“Patients who come in with low CD4 counts are often so sick they can’t walk, some are even unconscious. These patients often cannot provide sputum and need treatment as quickly as possible. Unlike with sputum tests, the TB LAM test can provide results in under an hour and patients can be started on treatment the very same day. This quick time-to-treatment saves lives,” she said.
An edited version of this story was also published in Health24