Submission ID 131797
| Issue/Objective | Sputum scarcity in routine HIV care can delay tuberculosis (TB) diagnosis for people living with HIV (PLHIV), undermining equitable access to timely treatment. This evaluation aimed to integrate urine Xpert MTB/RIF Ultra into HIV clinic workflows and quantify its incremental diagnostic yield over sputum Xpert, aligned with CCGH Sub theme 3 (from evidence to impact). |
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| Methodology/Approach | We conducted a six month operational evaluation in three PEPFAR supported HIV clinics in Ibadan, Nigeria. Readiness included workflow mapping and training 33 clinic and laboratory staff on consent, specimen handling, and testing procedures. Consenting PLHIV with presumptive TB provided paired urine and sputum specimens transported daily for Xpert testing (urine: Ultra; sputum: Xpert). Data were captured in REDCap; sputum Xpert served as the programmatic comparator. Incremental yield was assessed in Stata v18. |
| Results | Among 111 participants (70.3% female; 98.2% on ART), all provided both specimens. Urine Ultra detected MTB in 12/111 (10.8%) with 3/111 (2.7%) invalids, while sputum Xpert detected MTB in 3/111 (2.7%) with 1/111 (0.9%) invalid. All sputum positive cases were urine positive; urine testing identified nine additional MTB detections (incremental yield +8.1 percentage points). Median turnaround time from collection to clinic result return was 24 hours. Intermittent commodity stockouts were mitigated through NTBLCP support and proactive stock monitoring. |
| Discussion/Conclusion | Urine Ultra integration was operationally feasible and improved TB case detection in presumptive PLHIV, supporting more equitable diagnostic access when sputum is constrained. For scale up, programs should strengthen commodity supply chains and routinely monitor turnaround time and invalid rates within HIV/TB platforms-translating implementation evidence into accountable practice consistent with CCGH's equity focused theme. |
| Presenters and Affiliations | Charity Sanni Institute of Human Virology, Nigeria Kazeem Ayodeji Institute of Human Virology, Nigeria Veronica Ajuka-Patrick Institute of Human Virology, Nigeria Stella Ijioma Institute of Human Virology, Nigeria Joseph Ozigbo Institute of Human Virology, Nigeria Miriam Bathnna Institute of Human Virology, Nigeria Felix Agaga Odama Institute of Human Virology, Nigeria Hasiya Bello IHVN Ejilude Oluwaseun Institute of Human Virology, Nigeria Temitope Adetiba Institute of Human Virology, Nigeria Adebayo Opeyemi Institute of Human Virology, Nigeria Olayemi Olupitan Institute of Human Virology, Nigeria Aderonke Agbaje Institute of Human Virology, Nigeria Temitope Ilori National Agency for the Control of Aids, Nigeria Margaret Zamzu The Global Fund to fight AIDS, Tuberculosis and Malaria, Global Health Campus, Geneva, Switzerland Evaezi Okpokoro Institute of Human Virology, Nigeria |
