Urine Test for TB Increasing, While tuberculosis (TB) is the top killer of people living with HIV, TB is also harder to diagnose in people living with HIV than in people who are not. What is more, TB is particularly difficult to diagnose in people living with HIV who have compromised immune systems.
Imagine, for example, someone living with HIV is very sick and lying in hospital. It is not known whether or not the person has TB. They may not be coughing much and may be unable to cough up the sputum required for the standard molecular TB test, a test that takes at least a few hours to do. This is where the urinary LAM (or ULAM) test can make all the difference. Urine Test for TB Increasing, Much like a pregnancy test, all that is required is a urine sample and the test kit. It takes 25 minutes to get a result. If a diagnosis is confirmed, the patient can immediately be started on TB treatmen, Yet, while the case for using ULAM in such circumstances is compelling, the World Health Organization (WHO) first recommended its use in 2015, and uptake of the test in South Africa has been slow. But, based on presentations at the 7th South African TB Conference recently held in Durban, use of the test is now increasing. The WHO published an expanded recommendation for ULAM in 2019. LAM stands for lipoarabinomannan, which is a component of the outer cell wall of the TB bacterium. Some LAM that is shed from TB bacteria can be excreted through urine. A Urinary LAM (ULAM) test is simply a test that looks for these LAM fragments in urine. One benefit of ULAM is that urine samples are much easier to obtain than sputum. The current gold standard molecular TB test used in South Africa, the GeneXpert, requires people to cough up sputum – which many, especially children and people living with HIV who have compromised immune systems find hard to do. Professor Keertan Dheda, general physician, pulmonologist, and critical care specialist who heads up the Division of Pulmonology at Groote Schuur Hospital and the University of Cape Town told the conference the challenge with HIV patients is that they are sputum scarce and struggle to cough. “You can’t really get a proper sputum (sample) because most of them are not able to cough it up.
That is why we need a test that works well for these patients,” he said. One benefit of ULAM is that urine samples are much easier to obtain than sputum. Another benefit of ULAM is that it produces results in 25 minutes and the test can be done at the point of care – be it in a clinic or at a patient’s bedside. Most of the molecular TB tests available in South Africa require samples to be transported to a lab and results are available in at best a few hours. Diagnosing TB and doing so quickly really matters when someone is sick enough to be in hospital. “About 50% of TB deaths in the hospitals are undiagnosed hence a rapid diagnosis is needed,” said Dheda. “ULAM is indicated for people living with HIV with advanced disease, which means they are already very sick,” said Neeltjie Le Roux, Quality Improvement Advisor at Aurum Institute (an NGO). “As healthcare workers, we do not want to miss TB in people living with HIV, as we don’t want patients to die from a disease we can cure. Thus, starting with TB treatment promptly is vital and this test helps us to do that.” Urine Test for TB Increasing, The quicker turnaround time also has benefits for clinic patients with compromised immune systems who haven’t been hospitalised “In terms of time,Urine Test for TB Increasing, with ULAM the test result is within 25 minutes, while the patient is still present, whereas with Gene Xpert the results take at least six hours (and this is after it was received and processed at the lab), thus patients have to wait at least a day or two for diagnosis, and have to return to the facility for their result and treatment initiation – causing a delay in starting treatment and at a higher cost for patients to return because they will need transport or a day out from work, among other things,” said Le Roux. “It is still important to follow up with sputum tests when the patient can produce sputum/phlegm, as ULAM can tell us if the patient has TB, but it does not distinguish between drug-sensitive TB or drug-resistant TB,” said Le Roux. “Research found it (ULAM) results in quicker TB diagnosis, reduces mortality (by having a quicker diagnosis and being able to start patients earlier on treatment), and it greatly improves diagnostic yield when used with other tests.”
Source: This news is originally published by allafrica