CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

770 TRENDS IN HIV- AND SEX-STRATIFIED TUBERCULOSIS CASE NOTIFICATIONS IN BLANTYRE, MALAWI

HIV/TB burden setting. We also evaluated the additive value of CXR to Xpert MTB/Rif test in smear-negative TB diagnosis in the same patient population. Methods: HIV co-infected presumptive TB patients were recruited from the Infectious Diseases Institute outpatient clinic and medical wards of Mulago Hospital, Uganda. Chest radiographs were reviewed by two independent experienced radiologists using a standardised evaluation form. CXR interpretation with regard to TB was either positive (consistent with TB) or negative (normal or unlikely TB). Mycobacterial sputum and blood cultures were used as reference standard. Results: 366 HIV co-infected smear-negative presumptive TB patients (female, 63.4%; hospitalized, 68.3%) had technically adequate chest radiographs. Median (IQR) age was 32 (28-39) years and CD4 count 106 (24-308) cells/mm 3 . 81/366 (22.1%) had positive MTB cultures. 187/366 (51.1%) had CXR interpreted as consistent with TB, of which 55 (29.4%) had culture confirmed TB. Sensitivity and specificity of CXR interpretation in culture-positive, smear-negative TB diagnosis were 67.9% (95%CI 56.6-77.8) and 53.7% (95%CI 47.7-59.6) respectively while Xpert MTB/Rif sensitivity and specificity were 65.4% (95%CI 54.0-75.7) and 95.8% (95%CI 92.8-97.8) respectively. Addition of CXR to Xpert had overall sensitivity of 87.7% (95%CI 78.5-93.9) and specificity of 51.6% (95%CI 45.6-57.5); with 86.2% (95%CI 75.3-93.5) and 48.1% (95%CI 40.7-55.6) respectively among inpatients and 93.8% (95%CI 69.8-99.8) and 58.0% (95%CI 47.7-67.8) respectively among outpatients (Table ). Conclusion: In this high HIV/TB burden setting, CXR interpretation by expert radiologists had low diagnostic utility in HIV co-infected patients presenting with TB symptoms and negative smear. Addition of CXR to Xpert MTB/Rif did not complement its performance in smear-negative TB diagnosis in HIV. CXR may not have a role in settings where Xpert MTB/Rif is available as a TB diagnostic.

Marriott Nliwasa 1 , Augustine Choko 2 , Mphatso Mwapasa 1 , Daniel Grint 3 , Peter MacPherson 4 , Elizabeth L. Corbett 3 1 University of Malawi, Blantyre, Malawi, 2 Malawi–Liverpool–Wellcome Trust Clinical Rsr Prog, Blantyre, Malawi, 3 London School of Hygiene & Tropical Medicine, London, UK, 4 Liverpool School of Tropical Medicine, Liverpool, UK Background: Understanding of tuberculosis (TB) epidemiology helps in the design of interventions to reduce disease burden in an area. The objective of the study was to describe trends in smear positive TB case notification rates (CNRs) in relation to an active case finding (ACF) intervention in Blantyre, Malawi and investigate TB case notification rate (CNR) ratios associated with sex, age and HIV status. Methods: An extended monitoring and evaluation systemwas set up to improve reporting of TB cases (numerator for CNRs) in Blantyre in 2009-16. An electronic register was used to record TB patient’s age, gender, HIV status and residence in ACF areas. Age-sex population sizes (denominators) were estimated using the national census and study area enumeration and HIV prevalence survey data, adjusting for yearly growth rate. Results: In quarter 1 of 2011, before the introduction of TB ACF, the smear positive TB CNR in Blantyre was 220 per 100, 000 (95% CI: 169 to 282) - see Figure. When ACF was introduced in 2011, TB CNRs increased significantly in ACF areas to 405 per 100, 000 (95% CI: 335 to 486) and fell again to pre-ACF levels (206 per 100, 000 [95% CI: 157 to 266]) in 2014, when ACF was stopped. TB CNRs rose in all age and sex groups during ACF period, notably in 30 to 39-year-old men (from 360 per 100, 000 to 638 per 100,000, p=<0.001). Factors associated with higher adjusted TB CNR ratio were HIV positive status (12.7 [95% CI: 11.3 to 14.2]); male sex (2.32 [95% CI: 1.97 to 2.72]); and older age, for example, 40 to 49-year age group (1.34 [95% CI: 1.10 to 1.64]) versus 16 to 19-year age group. Conclusion: The TB incidence in Blantyre is highest in men and those HIV- positive. Community TB ACF increased smear positive TB case detection in these key groups. Appropriately designed TB prevention and care strategies can reduce TB transmission in Africa’s urban areas.

Poster Abstracts

772 C-REACTIVE PROTEIN TO SCREEN FOR HIV-ASSOCIATED TUBERCULOSIS IN SOUTH AFRICA Adrienne E. Shapiro 1 , Ting Hong 1 , Sabina Govere 2 , Dumezweni Ntshangase 2 , Hilary Thulare 2 , Mahomed-Yunus Moosa 3 , Afton Dorasamy 4 , Connie L. Celum 1 , Jacques H. Grosset 5 , Paul K. Drain 1 1 University of Washington, Seattle, WA, USA, 2 AIDS Healthcare Foundation, Durban, South Africa, 3 University of KwaZulu-Natal, Durban, South Africa, 4 KwaZulu-Natal Research Institute for TB and HIV, Durban, South Africa, 5 The Johns Hopkins University, Baltimore, MD, USA Background: A low-cost, point-of-care screening test for HIV-associated tuberculosis (TB) could accelerate antiretroviral therapy (ART) and isoniazid preventive therapy (IPT). C-reactive protein (CRP) is a non-specific inflammatory marker elevated during active TB and other pyogenic infections and can be measured using a rapid fingerstick assay. We assessed the diagnostic accuracy of CRP as a screening test for active TB in HIV-infected ambulatory adults. Methods: We measured CRP levels in stored plasma specimens collected from HIV-infected adults at HIV testing at an urban clinic in KwaZulu-Natal, South Africa. We collected sputum from all participants for TB culture and measured CD4 T-cell counts. We calculated the diagnostic accuracy for HIV-associated pulmonary TB of: 1) CRP >5 mg/L (manufacturer threshold); and 2) the World Health Organization (WHO)-endorsed 4-symptom screen (cough, fever, night sweats, weight loss), compared to the diagnostic gold standard, a positive TB culture. Results: Among 425 HIV-infected persons not on ART, 58%were female, median age was 32 years (IQR 27-39), and median CD4 was 306/mm 3 (IQR 176-

771 ROLE OF CHEST X-RAY IN DIAGNOSIS OF HIV-ASSOCIATED SMEAR- NEGATIVE TB IN UGANDA Lydia Nakiyingi 1 , John Mark Bwanika 1 , Willy Ssengooba 2 , Frank Mubiru 1 , Harriet Mayanja-Kizza 2 , Jerrold Ellner 3 , Susan E. Dorman 4 , Yukari C. Manabe 5 1 Infectious Disease Institute, Kampala, Uganda, 2 Makerere University College of Health Sciences, Kampala, Uganda, 3 Boston University, Boston, MA, USA, 4 Medical University of South Carolina, Charleston, SC, USA, 5 Johns Hopkins Hospital, Baltimore, MD, USA Background: Chest X-ray (CXR) interpretation remains a central component of current World Health Organization recommendations for diagnosis of smear-negative tuberculosis (TB) in high HIV prevalence settings. National TB guidelines for most resource-limited settings still include use of CXR as part of their TB diagnostic algorithms. With its low specificity, high maintenance and operational costs, we evaluated accuracy of CXR for detecting culture-positive TB among HIV co-infected smear-negative presumptive TB patients in a high

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