Screening for tuberculosis with Xpert MTB/RIF versus fluorescent microscopy among adults newly diagnosed with HIV in rural Malawi: a cluster randomized trial (CHEPETSA)

Lucky G Ngwira, Elizabeth L Corbett, McEwen Khundi, Grace L Barnes, Austin Nkhoma, Michael Murowa, Silvia Cohn, Lawrence H Moulton, Richard E Chaisson, David W Dowdy
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America 2018 July 27

Background: Tuberculosis (TB) remains the leading cause of death among HIV-positive individuals globally. Screening for TB at the point of HIV diagnosis with a high-sensitivity assay presents an opportunity to reduce mortality.

Methods: We performed a cluster randomized trial of TB screening among adults newly diagnosed with HIV in 12 primary health clinics in rural Thyolo, Malawi ( NCT01450085). Clinics were allocated in a 1:1 ratio to perform either point-of-care Xpert MTB/RIF (Xpert) or point-of-care light-emitting diode fluorescence microscopy (LED FM) for individuals screening positive for TB symptoms. Asymptomatic participants were offered isoniazid preventive therapy in both arms. Investigators, but not clinic staff or participants, were masked to allocation. Our primary outcome was the incidence rate ratio (RR) of all-cause mortality within 12 months of HIV diagnosis.

Results: Prevalent TB was diagnosed in 24 (2.4%) of 1001 individuals enrolled in clinics randomized to Xpert, versus 10 (1.2%) of 841 in clinics randomized to LED FM. All-cause mortality was 22% lower in the Xpert arm than in the LED FM arm (6.7 versus 8.6 per 100 person-years, RR 0.78; 95% confidence interval [CI]: 0.58-1.06). A planned subgroup analysis suggested that participants with more advanced HIV (World Health Organization clinical stage III or IV) disease had lower mortality in clinics randomized to Xpert than to LED FM (RR 0.43, 95%CI: 0.22-0.87).

Conclusion: In rural Malawi, using point-of-care Xpert MTB/RIF to test symptomatic patients for TB at the time of HIV diagnosis reduced all-cause 12-month mortality among individuals with advanced HIV.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"