Trends in HIV seroprevalence among tuberculosis patients in 4 districts, 2005–6 survey and 2006–7 surveys.

<p>Trends in HIV seroprevalence among tuberculosis patients in 4 districts, 2005–6 survey and 2006–7 surveys.</p

HIV seroprevalence among tuberculosis patients in 15 districts in India, 2006–2007.

a<p>Districts stratified by mean HIV seroprevalence in antenatal clinic (ANC) surveillance sites, 2003–2005. Low <0.5%, Medium = 0.51–1.0%, High >1.0%.</p

Districts selected for the survey.

<p>District selection stratified by mean HIV seroprevalence in antenatal clinic (ANC) surveillance sites, 2003–2005. Districts shaded blue had mean 2003–2005 ANC HIV seroprevalence 0–0.5%, yellow districts had ANC HIV seroprevalence 0.51–1.0%, and red districts had ANC HIV seroprevalence >1.0%. The districts of Davangere, Guntur, Nasik, and Tiruvanamalai were selected in the previous years' survey, and were purposively selected again for trend analysis.</p

Survey enrollment and inclusion, with reasons for non-eligibility and non-enrollment into survey.

<p>Survey enrollment and inclusion, with reasons for non-eligibility and non-enrollment into survey.</p

Catching the Missing Million: Experiences in Enhancing TB & DR-TB Detection by Providing Upfront Xpert MTB/RIF Testing for People Living with HIV in India

<div><p>Background</p><p>A critical challenge in providing TB care to People Living with HIV (PLHIV) is establishing an accurate bacteriological diagnosis. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents results from PLHIV taking part in a large demonstration study across India wherein upfront Xpert MTB/RIF testing was offered to all presumptive PTB cases in public health facilities.</p><p>Method</p><p>The study covered a population of 8.8 million across 18 sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each TU. All HIV-infected patients suspected of TB (both TB and Drug Resistant TB (DR-TB)) accessing public health facilities in study area were prospectively enrolled and provided upfront Xpert MTB/RIF testing.</p><p>Result</p><p>2,787 HIV-infected presumptive pulmonary TB cases were enrolled and 867 (31.1%, 95% Confidence Interval (CI) 29.4‒32.8) HIV-infected TB cases were diagnosed under the study. Overall 27.6% (CI 25.9–29.3) of HIV-infected presumptive PTB cases were positive by Xpert MTB/RIF, compared with 12.9% (CI 11.6–14.1) who had positive sputum smears. Upfront Xpert MTB/RIF testing of presumptive PTB and DR-TB cases resulted in diagnosis of 73 (9.5%, CI 7.6‒11.8) and 16 (11.2%, CI 6.7‒17.1) rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high 97.7% (CI 89.3‒99.8), with no significant difference with or without prior history of TB treatment.</p><p>Conclusion</p><p>The study results strongly demonstrate limitations of using smear microscopy for TB diagnosis in PLHIV, leading to low TB and DR-TB detection which can potentially lead to either delayed or sub-optimal TB treatment. Our findings demonstrate the usefulness and feasibility of addressing this diagnostic gap with upfront of Xpert MTB/RIF testing, leading to overall strengthening of care and support package for PLHIV.</p></div

Demographic profile of the HIV-infected presumptive TB and DR-TB cases enrolled under the study.

<p>Demographic profile of the HIV-infected presumptive TB and DR-TB cases enrolled under the study.</p

Model parameters.

<p>Model parameters.</p

Scaling-up the Xpert MTB/RIF assay for the detection of tuberculosis and rifampicin resistance in India: An economic analysis

<div><p>Background</p><p>India is considering the scale-up of the Xpert MTB/RIF assay for detection of tuberculosis (TB) and rifampicin resistance. We conducted an economic analysis to estimate the costs of different strategies of Xpert implementation in India.</p><p>Methods</p><p>Using a decision analytical model, we compared four diagnostic strategies for TB patients: (i) sputum smear microscopy (SSM) only; (ii) Xpert as a replacement for the rapid diagnostic test currently used for SSM-positive patients at risk of drug resistance (i.e. line probe assay (LPA)); (iii) Upfront Xpert testing for patients at risk of drug resistance; and (iv) Xpert as a replacement for SSM for all patients.</p><p>Results</p><p>The total costs associated with diagnosis for 100,000 presumptive TB cases were: (i) US$619,042 for SSM-only; (ii) US$ 575,377 in the LPA replacement scenario; (iii) US$720,523 in the SSM replacement scenario; and (iv) US$ 1,639,643 in the Xpert-for-all scenario. Total cohort costs, including treatment costs, increased by 46% from the SSM-only to the Xpert-for-all strategy, largely due to the costs associated with second-line treatment of a higher number of rifampicin-resistant patients due to increased drug-resistant TB (DR-TB) case detection. The diagnostic costs for an estimated 7.64 million presumptive TB patients would comprise (i) 19%, (ii) 17%, (iii) 22% and (iv) 50% of the annual TB control budget. Mean total costs, expressed per DR-TB case initiated on treatment, were lowest in the Xpert-for-all scenario (US$ 11,099).</p><p>Conclusions</p><p>The Xpert-for-all strategy would result in the greatest increase of TB and DR-TB case detection, but would also have the highest associated costs. The strategy of using Xpert only for patients at risk for DR-TB would be more affordable, but would miss DR-TB cases and the cost per true DR-TB case detected would be higher compared to the Xpert-for-all strategy. As such expanded Xpert strategy would require significant increased TB control budget to ensure that increased case detection is followed by appropriate care.</p></div

Rifampicin resistant HIV-infected TB cases diagnosed under the study.

<p><i>Abbreviations—OR = Odds Ratio</i>, <i>CI = Confidence interval</i></p><p>Rifampicin resistant HIV-infected TB cases diagnosed under the study.</p

Enrolment of HIV infected presumptive TB and DR TB cases under the study and TB and Rifampicin resistant TB case detection by Xpert MTB/RIF.

<p>Enrolment of HIV infected presumptive TB and DR TB cases under the study and TB and Rifampicin resistant TB case detection by Xpert MTB/RIF.</p