Slogotskaya, L. | bioRxiv Science

bioRxiv2020

The effectiveness of prevention and early detection of tuberculosis in people living with HIV

Background The difficult epidemic situation caused by TB/HIV co-infection and, accordingly, the need to strengthen measures for the prevention of tuberculosis among HIV patients, identified the need to create a model of collaborating tuberculosis management facilities and AIDS centers.Study purpose analysis of the effectiveness of measures used in Moscow to prevent the spread of HIV/tuberculosis co-infection based on the developed new algorithm.Materials and methods The design of the study – a full-design retrospective cohort study of all HIV patients in tuberculosis preventive care and early detection unit for HIV patients (PCED TB Unit), which was organized in 2014 as a subdivision of Moscow TB Center on the premises of the Moscow AIDS Center. The study was conducted from 2014 to 2017. 22,190 HIV-infected patients were examined. In order to detect tuberculosis infection, all HIV patients were referred for skin testing with preparation Diaskintest, which represents recombinant proteins CFP10-ESAT6 and persons with a positive and doubtful reaction were examined for the diagnosis of tuberculosis and latent tuberculosis infection (LTBI). Preventive therapy (PT) was prescribed to patients with LTBI, which was also received by those with CD4+count ≤350 cells/mm3, regardless of the results of a skin test.Results Over a period of 4 years, Diaskintest was performed in 19,777 people. Positive results were in 857 patients (4.3%) [95% CI 4.1-4.6]. 131 patients were diagnosed with tuberculosis, the rest - with LTBI. The effectiveness of PT was estimated by the number of TB cases detected among HIV patients who completed PT (1757) and those who did not receive it (5990). The notification rate of TB in the first group was 228 [95%CI 65-582] per 100,000 patients, in the second 1486 [95%CI 1195–1825], which is 6,5 times higher. To assess the effectiveness of early detection of TB, the proportion of severity forms of pulmonary TB diagnosed in 87 patients at the PCED TB Unit using a new algorithm in 2016-2017 were compared with 411patients detected in different medical organizations of Moscow using conventional methods. The proportion of disseminated TB was lower in the first group (23.0% versus 44.5%) (p<0.01).Conclusion The study showed that the integration of the two services allows increases the accessibility of TB care and makes a significant contribution to improving the effectiveness of measures to prevent the TB spread among HIV patients. It supports the necessity of treating LTBI detected using the Diaskintest to prevent TB in HIV-infected patients. Significant effects that have been achieved include a reduction in the TB notification rate among HIV patients, improvement of the diagnostic structure of registered TB cases as a result of their timely detection.View Full Text

immunology↗

bioRxiv2018

Comparative sensitivity of the test with tuberculosis recombinant allergen, containing ESAT6-CFP10 protein, and Mantoux test with 2 TU PPD-L in newly diagnosed tuberculosis children and adolescents in Moscow

Background. A group of Russian scientists has developed Diaskintest, which comprises Mycobacterium tuberculosis-specific recombinant proteins CFP10-ESAT6, for skin testing (0.2 {micro}g/0.1 ml).\n\nStudy purpose: to evaluate the comparative sensitivity of TST with 2 TU PPD-L and a skin test with tuberculous recombinant allergen (Diaskintest) containing the ESAT6-CFP10 protein in children and adolescents with newly diagnosed respiratory tuberculosis during mass screening in the primary medical service in Moscow, 2013-2016.\n\nMaterials and methods. The trial was a comprehensive retrospective group study of children and adolescents diagnosed in Moscow with respiratory tuberculosis in 2013-2016, aged 0 to 17 years inclusive. From 441 patients selected for analysis 408 patients had both tests (TST with 2 TU PPD-L and Diaskintest) performed, in 193 patients both tests were given simultaneously, of them 162 patients were BCG-vaccinated.\n\nResults. Comparative results of both tests in 408 patients with tuberculosis: at cut-off 5 mm, both tests has similar sensitivity: Diaskintest 98.3 % (95 % CI 97.0-99.6 %), TST 98.0 % (95 % CI 96.7-99.4 %), at cut-off 10 mm, the sensitivity decreases for both tests: Diaskintest 90.0 % (95 % CI 87.0-93.0 %), TST 88.7 % (95 % CI 85.6-91.9 %), but at cut-off 15 mm, the decrease in sensitivity is statistically significant: for Diaskintest 61.5 % (95 % CI 56.7-66.3 %), and for TST 46.3 % (95 % CI 41.4-51.3 %), p <0.0001.\n\nThe results of simultaneous setting of tests on different hands in 193 people (including 162 BCG-vaccinated), do not differ from the results for 408 people.\n\nThe correlation between the results of Diaskintest and TST was significant in all groups.\n\nConclusion. In children and adolescents with respiratory tuberculosis, Diaskintest of 0.2 {micro}g/ml and the Mantoux test with 2 TU PPD-L have high sensitivity (98%) at a cut-off of 5 mm; however, at cut-off 15 mm sensitivity is significantly reduced, and the decrease is more pronounced in the Mantoux test. The advantage of Diaskintest is that, unlike the Mantoux test, it has high specificity under the conditions of mass BCG vaccination. The test is cost-effective, simple to carry out, and can be used in mass screening.

epidemiology↗