The impact of targeted screening for latent tuberculosis in people living with HIV

Why is this important?

• Targeted LTBI screening of all PLHIV residing in low TB burden countries improves diagnosis, treatment uptake and outcomes.

Principle results

• 1,053 patients; median age: 42 years (interquartile range: 36–49).
• Ethnicity: 47.3% (498) Black African ethnicity, 46.8% (388) White ethnicity; 51.1% born in sub-Saharan Africa, 40.0% born in Europe and Central Asia.
• 11.2% (118) of PLHIV tested positive for DLIG.
• 117 PLHIV were positive for ITL, 85.5% (100) started chemoprophylaxis; compliance rate: 96% (n = 96/100).
• Positivity to DLIG, ITL, univariate analysis:
  • Black African ethnicity: odds ratio (OR) of 1.
  • South Asian ethnicity: OR 1.06; P=0.84.
  • Country of birth in sub-Saharan Africa: OR of 7.80; P<0.001.
  • Southeast Asia and Pacific: OR 5.79; P<0.001.
• 81.4% of patients (96/118) from sub-Saharan Africa tested positive (DLIG positivity rate: 17.8%).
• DLIG positivity rate for patients of Black African and South Asian ethnicity: 18.1% for both.
• Yield based on threshold used for testing by DLIG: TB incidence greater than 150 cases/100,000 plus all countries in sub-Saharan Africa at birth: 89.8% of LTBI cases were correctly identified, and testing was reduced by 46.1%.

Methodology

• This is a prospective, systematic and programmatic LTBI screening intervention for PLHIV in care in Leicester, UK, to understand LTBI screening uptake/uptake. of chemoprophylaxis and related factors.
• Funding: no funding has been communicated.

Limits

• The overall test positivity rate by DLIG is underestimated.
• Country-specific TB incidence was only collected at one time point.