EDCTP Alumni Network

Fostering excellence and collaboration in the next generation of researchers

Call Career Development Fellowship (CDF)
Programme EDCTP2
Start Date 2019-11-01
End Date 2022-10-31
Project Code TMA2018CDF-2351
Status Active

Title

Evaluation of alternative bacteriological measures of response to therapy during the initial 16-weeks of MDR-TB treatment

Objectives

During the first 16 weeks of MDR-TB treatment I will: 1) To examine the correlations of FDA smear microscopy, PMA-Xpert Ct value &16s rRNA (MBLA) with MGIT-TTP as a reference standard. 2) To evaluate the ability of FDA smear microscopy, PMA-Xpert Ct value, MBLA in predicting 16-weeks MGIT culture conversion (outcome). 3) To evaluate the influence of patient clinical characteristics, baseline resistance profiles, adherence and HIV-status to the performance of the alternative measures of response

Host Organisation

Institution Country
Makerere University Uganda

Participants

Name Institution Country
Dr. Wilber Sabiiti University Of St. Andrews United Kingdom

Study Design

Prospective observational study

Sites

Mulago National Referral Hospital, Tuberculosis Treatment Unit, Ward 5 and 6

Students Supervised

Type Name Title University Start Date End Date
Masters Serestine Mujumbi MSc. Immunology and Clinical Microbiology Makerere University 2021 2022
PhD Emmanuel Musisi PhD Novel Molecular diagnosis of TB University of St. Andrews 2019 2021

Current Organisation

Makerere University

Current Job Title

Scientific Director of the Mycobacteriology Research Unit

Students Supervised

Type Name Title University Start Date End Date
Willy Ssengooba

Education

Institution Degree Year
Makerere University, Kampala, Uganda Biomedical Sciences 2005-09-01
Makerere University, Kampala, Uganda Master of Health Services Research 2011-09-01
Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands PhD, Molecular Microbiology 2017-06-13

Areas Of Specialisation

Tuberculosis (TB)

Grants

Grant Code:
RIA2018D-2511
Source of funding:
European and Developing Countries Clinical Trials Partnership (EDCTP)
Amount:
2999989.25
Role:
Co-Applicant
Start Date:
2020-01-01
End Date:
2024-01-01

Publications

Authors:
Ssengooba, W.
Kirenga, B.
Muwonge, C.
Kyaligonza, S.
Kasozi, S.
Mugabe, F.
Boeree, M.
Joloba, M.
Okwera, A.
Date:
2016-01-01
Journal:
African Health Sciences
Content:
Identifiers:
Authors:
Asiimwe BB , author
Bagyenzi GB , author
Ssengooba W , author
Mumbowa F , author
Mboowa G , author
Wajja A , author
Mayanja-Kiiza H , author
Musoke PM , author
Wobudeya E , author
Kallenius G , author
Joloba ML , author
Date:
2013-01-01
Journal:
Content:
Identifiers:
Authors:
Willy Ssengooba , author
Lydia Nakiyingi , author
Edgar Kigozi , author
Yukari C. Manabe , author
Moses L. Joloba , author
Date:
2019-04-29
Journal:
Content:
Identifiers:
Authors:
Date:
2021-02-23
Journal:
Journal of medical microbiology
Content:
Introduction. Drug resistant tuberculosis remains a worldwide problem that requires prompt diagnosis.Hypothesis/Gap statement. The WHO recommended direct, rapid Xpert MTB/RIF is prohibitively costly, therefore, there is a need to validate a rapid, affordable DST for use in low- and middle-income settings.Aim. The technical performance and time to results of a simple, direct microscopy-based slide DST (SDST) assay for diagnosis of rifampicin-resistant TB was evaluated in Uganda.Methodology. Sputum samples from 122 smear-positive re-treatment TB patients presenting to the TB treatment centre at Uganda's National Referral Hospital, Mulago, Kampala, Uganda were examined. The sputum samples were tested by the direct SDST which was compared to the indirect Lowenstein Jensen Proportion Method (LJDST) method as the gold standard. The time to results was defined as the time from DST setting to results interpretation. The results were further analysed for sensitivity and specificity as well as agreement between LJDST and SDST for rifampicin resistance determination.Results. A total of 117 smear positive sputum samples with valid results for both tests were compared. The median time to results for SDST was 14 days with an interquartile range (IQR) of 10-14 days compared to 60 days with IQR of 60-75 days for LJDST. The number for rifampicin resistance by the gold standard LJDST was 26. The SDST had a sensitivity of 96 % (95 %; CI 81-99 %) and a specificity of 97.8 % (95 %; CI 93-100 %). The Positive Predictive and Negative Predictive values for SDST were 92.3 % (95 %; CI 76.8-99 %) and 98.9 % (95 %; CI 94-100 %), respectively. The kappa agreement between SDST and LJDST was 92.3 %.Conclusion. The SDST was found to be a rapid and accurate direct test for the detection of rifampicin resistance among retreatment TB cases in low-income settings.
Identifiers:
Authors:
Muttamba W , author
Ssengooba W , author
Sekibira R , author
Kirenga B , author
Katamba A , author
Joloba M , author
Date:
2018-01-01
Journal:
PloS one
Content:
Identifiers:
Authors:
Dharan, N.J.
Amisano, D.
Mboowa, G.
Ssengooba, W.
Blakemore, R.
Kubiak, R.W.
Armstrong, D.T.
Jones, M.
Manabe, Y.C.
Joloba, M.L.
Ellner, J.J.
Dorman, S.E.
Alland, D.
Date:
2015-01-01
Journal:
Journal of Clinical Microbiology
Content:
Identifiers:
Authors:
Ssengooba, W.
Lukoye, D.
Meehan, C.J.
Kateete, D.P.
Joloba, M.L.
De Jong, B.C.
Cobelens, F.G.
Van Leth, F.
Date:
2017-01-01
Journal:
International Journal of Tuberculosis and Lung Disease
Content:
Identifiers:
Authors:
Nakiyingi, L.
Nonyane, B.A.S.
Ssengooba, W.
Kirenga, B.J.
Nakanjako, D.
Lubega, G.
Byakika-Kibwika, P.
Joloba, M.L.
Ellner, J.J.
Dorman, S.E.
Mayanja-Kizza, H.
Manabe, Y.C.
Date:
2015-01-01
Journal:
PLoS ONE
Content:
Authors:
Date:
2020-12-01
Journal:
Nature Communications
Content:
Identifiers:
Authors:
Ssengooba, W.
de Jong, B.C.
Joloba, M.L.
Cobelens, F.G.
Meehan, C.J.
Date:
2016-01-01
Journal:
BMC Infectious Diseases
Content:
Authors:
Nantongo, J.M.
Wobudeya, E.
Mupere, E.
Joloba, M.
Ssengooba, W.
Kisembo, H.N.
Lubega, I.R.
Musoke, P.M.
Date:
2013-01-01
Journal:
BMC Pediatrics
Content:
Authors:
Manson, A.L.
Cohen, K.A.
Abeel, T.
Desjardins, C.A.
Armstrong, D.T.
Barry, C.E.
Brand, J.
Chapman, S.B.
Cho, S.-N.
Gabrielian, A.
Gomez, J.
Jodals, A.M.
Joloba, M.
Jureen, P.
Lee, J.S.
Malinga, L.
Maiga, M.
Nordenberg, D.
Noroc, E.
Romancenco, E.
Salazar, A.
Ssengooba, W.
Velayati, A.A.
Winglee, K.
Zalutskaya, A.
Via, L.E.
Cassell, G.H.
Dorman, S.E.
Ellner, J.
Farnia, P.
Galagan, J.E.
Rosenthal, A.
Crudu, V.
Homorodean, D.
Hsueh, P.-R.
Narayanan, S.
Pym, A.S.
Skrahina, A.
Swaminathan, S.
Van Der Walt, M.
Alland, D.
Bishai, W.R.
Cohen, T.
Hoffner, S.
Birren, B.W.
Earl, A.M.
Date:
2017-01-01
Journal:
Nature Genetics
Content:
Identifiers:
Authors:
Muttamba W , author
Kirenga B , author
Ssengooba W , author
Sekibira R , author
Katamba A , author
Joloba ML , author
Date:
2018-12-01
Journal:
The American journal of tropical medicine and hygiene
Content:
Identifiers:
Authors:
Willy Ssengooba , author
Jean de Dieu Iragena , author
Lydia Nakiyingi , author
Serestine Mujumbi , author
Eric Wobudeya , author
Robert Mboizi , author
David Boulware , author
David B. Meya , author
Louise Choo , author
Angela M. Crook , author
Kristen Lebeau , author
Moses Joloba , author
Anne-Marie Demers , author
Fiona V. Cresswell , author
Diana M. Gibb , author
Melissa B. Miller , editor
Date:
2020-08-24
Journal:
Journal of Clinical Microbiology
Content:
Identifiers:
Authors:
Gerald Mboowa , author
Carolyn Namaganda , author
Willy Ssengooba , author
Date:
2014-01-01
Journal:
BMC Infectious Diseases
Content:
Identifiers:
Authors:
Shah M , author
Ssengooba W , author
Armstrong D , author
Nakiyingi L , author
Holshouser M , author
Ellner JJ , author
Joloba M , author
Manabe YC , author
Dorman SE , author
Date:
2014-03-01
Journal:
Content:
Identifiers:
Authors:
Waako J , author
Verver S , author
Wajja A , author
Ssengooba W , author
Joloba ML , author
Colebunders R , author
Musoke P , author
Mayanja-Kizza H , author
Date:
2013-07-01
Journal:
Content:
Identifiers:
Authors:
Date:
2019-04-01
Journal:
Content:
BackgroundAmong HIV-positive individuals with CD4 ≤100 cells/mm3, M. tuberculosis (Mtb) bacteraemia is associated with a positive tuberculosis urine lipoarabinomannan (LAM) test. We conducted a retrospective study, to determine the effect of Mtb lineage on the performance of the Determine TB LAM lateral flow (LF-LAM) assay.MethodsThis was nested in a prospective TB diagnostics accuracy study among HIV-positive presumptive TB patients from Mulago National Referral Hospital, Kampala, Uganda, including both inpatients and outpatients. We considered data of 51 HIV-positive individuals with both pulmonary and Mtb bacteraemia. We also evaluated the effect of having mixed Mtb strains using both spoligotyping and MIRU-VNTR 24 loci methods.ResultsLF-LAM was; negative among 4 (7.8%; 95% CI, 2.17% to 18.8%), positive among 39 (76.5%; 95% CI, 62.5% to 87.2%) and indeterminate among 8 (15.7%; 95% CI, 7.0% to 28.5%) participants. Mtb lineages from blood samples were: Central Asian Strain (CAS; L3) 10/51 (19.6%) and Euro-American lineage (L4) 41/51 (80.4%). Mtb lineages from sputum samples were 7/51 (13.7%) L3 and 44/51 (86.3%) were L4. Among participants with L3 in blood, LFLAM was positive in 9 (90%; 95% CI, 55.4%–99.7%) whereas those with L4, LF-LAM was positive among 30 (73.2% 95% CI, 57.0% to 85.7%). For those with L3 in sputum, LF-LAM was positive among 7 (100%) and those with L4 was 32 (72.7%; 95% CI 57.2% to 85.0%). Two participants had mixed Mtb strains (all L4) and all LF-LAM positive (2+ and 4+).ConclusionOur study shows that M. tuberculosis lineage 3 may have more sensitivity to LF-LAM assay than lineage 4. The high number of indeterminate results with L4 requires more investigations. Our findings suggest that LF-LAM performance may differ by geographical regions depending on the dominant M. tuberculosis lineage.
Identifiers:
Authors:
Date:
2021-05-13
Journal:
PloS one
Content:

Introduction

Despite the limited evidence for its effectiveness, thermal screening at points of entry has increasingly become a standard protocol in numerous parts of the globe in response to the COVID-19 pandemic. We sought to determine the effectiveness of thermal screening as a key step in diagnosing COVID-19 in a resource-limited setting.

Materials and methods

This was a retrospective cross-sectional study based on a review of body temperature and Xpert Xpress SARS CoV-2 test results records for truck drivers entering Uganda through Mutukula between 15th May and 30th July 2020. All records missing information for body temperature, age, gender, and Xpert Xpress SARS CoV-2 status were excluded from the data set. A data set of 7,181 entries was used to compare thermal screening and Xpert Xpress SARS CoV-2 assay test results using the diagnostic statistical test in STATAv15 software. The prevalence of COVID-19 amongst the truck drivers based on Xpert Xpress SARS CoV-2 assay results was determined. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative Likelihood ratios were obtained using Xpert Xpress SARS CoV-2 assay as the gold standard.

Results

Based on our gold standard test, the proportion of persons that tested positive for COVID-19 was 6.7% (95% CI: 6.1-7.3). Of the 7,181 persons that were thermally screened, 6,844 (95.3%) were male. The sample median age was 38 years (interquartile range, IQR: 31-45 years). The median body temperature was 36.5°C (IQR: 36.3-36.7) and only n (1.2%) had a body temperature above 37.5°C. The sensitivity and specificity of thermal screening were 9.9% (95% CI: 7.4-13.0) and 99.5% (95% CI: 99.3-99.6) respectively. The positive and negative predictive values were 57.8 (95% CI: 46.5-68.6) and 93.9 (95% CI: 93.3-94.4) respectively. The positive and negative Likelihood Ratios (LRs) were 19 (95% CI: 12.4-29.1) and 0.9 (95% CI: 0.88-0.93) respectively.

Conclusion

In this study population, the use of Thermal screening alone is ineffective in the detection of potential COVID-19 cases at point of entry. We recommend a combination of screening tests or additional testing using highly sensitive molecular diagnostics such as Polymerase Chain Reaction.
Identifiers:
Authors:
Date:
2020-05-15
Journal:
PloS one
Content:
INTRODUCTION:Susceptibility testing for pyrazinamide (PZA), a cornerstone anti-TB drug is not commonly done in Uganda because it is expensive and characterized with technical difficulties thus resistance to this drug is less studied. Resistance is commonly associated with mutations in the pncA gene and its promoter region. However, these mutations vary geographically and those conferring phenotypic resistance are unknown in Uganda. This study determined the prevalence of PZA resistance and its association with pncA mutations. MATERIALS AND METHODS:Using a cross-sectional design, archived isolates collected during the Uganda national drug resistance survey between 2008-2011 were sub-cultured. PZA resistance was tested by BACTEC Mycobacterial Growth Indicator Tube (MGIT) 960 system. Sequence reads were downloaded from the NCBI Library and bioinformatics pipelines were used to screen for PZA resistance-conferring mutations. RESULTS:The prevalence of phenotypic PZA resistance was found to be 21%. The sensitivity and specificity of pncA sequencing were 24% (95% CI, 9.36-45.13%) and 100% (73.54% - 100.0%) respectively. We identified four mutations associated with PZA phenotypic resistance in Uganda; K96R, T142R, R154G and V180F. CONCLUSION:There is a high prevalence of phenotypic PZA resistance among TB patients in Uganda. The low sensitivity of pncA gene sequencing confirms the already documented discordances suggesting other mechanisms of PZA resistance in Mycobacterium tuberculosis.
Identifiers:
Authors:
Shah M , author
Dowdy D , author
Joloba M , author
Ssengooba W , author
Manabe YC , author
Ellner J , author
Dorman SE , author
Date:
2013-11-01
Journal:
Content:
Identifiers:
Authors:
Lee J , author
Armstrong DT , author
Ssengooba W , author
Park JA , author
Yu Y , author
Mumbowa F , author
Namaganda C , author
Mboowa G , author
Nakayita G , author
Armakovitch S , author
Chien G , author
Cho SN , author
Via LE , author
Barry CE 3rd , author
Ellner JJ , author
Alland D , author
Dorman SE , author
Joloba ML , author
Date:
2014-01-01
Journal:
Content:
Identifiers:
Authors:
Nakiyingi L , author
Nakanwagi P , author
Briggs J , author
Agaba T , author
Mubiru F , author
Mugenyi M , author
Ssengooba W , author
Joloba ML , author
Manabe YC , author
Date:
2018-02-01
Journal:
BMC infectious diseases
Content:
Identifiers:
Authors:
Ssengooba, W.
Meehan, C.J.
Lukoye, D.
Kasule, G.W.
Musisi, K.
Joloba, M.L.
Cobelens, F.G.
de Jong, B.C.
Date:
2016-01-01
Journal:
Infection, Genetics and Evolution
Content:
Authors:
Muwonge, A.
Malama, S.
Johansen, T.B.
Kankya, C.
Biffa, D.
Ssengooba, W.
Godfroid, J.
Djønne, B.
Skjerve, E.
Date:
2013-01-01
Journal:
PLoS ONE
Content:
Authors:
Ssengooba W , author
Respeito D , author
Mambuque E , author
Blanco S , author
Bulo H , author
Mandomando I , author
de Jong BC , author
Cobelens FG , author
García-Basteiro AL , author
Date:
2016-01-01
Journal:
Content:
Identifiers:
Authors:
Willy Ssengooba , author
Seyed Ehtesham Hasnain , editor
Germine Nakayita , author
Carolyn C. Namaganda , author
Moses L. Joloba , author
Date:
2018-06-28
Journal:
PLOS ONE
Content:
Identifiers:
Authors:
Date:
2019-04-03
Journal:
Journal of clinical microbiology
Content:
Tuberculous meningitis (TBM) is the most lethal manifestation of tuberculosis and requires rapid diagnosis and initiation of treatment to prevent death and serious neurological disability.….
Identifiers:
Authors:
Ssengooba W , author
Kateete DP , author
Wajja A , author
Bugumirwa E , author
Mboowa G , author
Namaganda C , author
Nakayita G , author
Nassolo M , author
Mumbowa F , author
Asiimwe BB , author
Waako J , author
Verver S , author
Musoke P , author
Mayanja-Kizza H , author
Joloba ML , author
Date:
2012-01-01
Journal:
Content:
Identifiers:
Authors:
Ssengooba, W.
Cobelens, F.G.
Nakiyingi, L.
Mboowa, G.
Armstrong, D.T.
Manabe, Y.C.
Joloba, M.L.
De Jong, B.C.
Date:
2015-01-01
Journal:
PLoS ONE
Content:
Authors:
Date:
2019-05-15
Journal:
PloS one
Content:
BACKGROUND:Determining mycobacterial burden is important in assessing severity of disease, evaluating infectiousness and predicting patient treatment outcomes. Mycobacterial burden assessed by smear microscopy grade and time to culture positivity is clearly interpretable by most physicians. GeneXpert (Xpert) has been recommended by WHO as a first line tuberculosis (TB) diagnostic test as an alternative to smear microscopy. Xpert gives cycle threshold (Ct) values as a potential measure for mycobacterial burden. For physicians to clearly interpret Ct values as measures of mycobacterial burden, this study compared the Xpert quantification capabilities with those of smear microscopy and culture. The study also determined a linear relationship between Xpert Ct values and MGIT culture time to positivity (MGIT-TTP) and associated factors. A cut off Ct value which best predicts smear positivity was also determined using the Receiver Operator Curve analysis method. RESULTS:Excluding missing results and rifampicin resistant TB cases, a moderately strong correlation of 0.55 between Xpert Ct value and smear grade was obtained. A weak correlation of 0.37 was obtained between Xpert Ct values and MGIT time to positivity while that between Xpert Ct values and LJ culture was 0.34. The Xpert Ct values were found to increase by 2.57 for every unit increase in days to positive and HIV status was significantly associated with this relationship. A cut off Ct value of 23.62 was found to best predict smear positivity regardless of HIV status. CONCLUSION:Our study findings show that GeneXpert Ct values are comparable to smear microscopy as a measure of M. tuberculosis burden and can be used to replace smear microscopy. However, given the low correlation between Xpert Ct value and culture positivity, Xpert Ct values cannot replace culture as a measure of M. tuberculosis burden among TB patients.
Identifiers:
Authors:
Thomas Clarke , author
Lauren Brinkac , author
Joanna Manoranjan , author
Alberto García-Basteiro , author
Harleen Grewal , author
Anthony Kiyimba , author
Elisa Lopez , author
Ragini Macaden , author
Durval Respeito , author
Willy Ssengooba , author
Michele Tameris , author
Granger Sutton , author
Date:
2020-05-28
Journal:
Content:
Identifiers:
Authors:
Date:
2021-06-01
Journal:
MicrobiologyOpen
Content:
Tuberculosis (TB) is the leading cause of death in humans by a single infectious agent worldwide with approximately two billion humans latently infected with the bacterium Mycobacterium tuberculosis. Currently, the accepted method for controlling the disease is Tuberculosis Directly Observed Treatment Shortcourse (TB-DOTS). This program is not preventative and individuals may transmit disease before diagnosis, thus better understanding of disease transmission is essential. Using whole-genome sequencing and single nucleotide polymorphism analysis, we analyzed genomes of 145 M. tuberculosis clinical isolates from active TB cases from the Rubaga Division of Kampala, Uganda. We established that these isolates grouped into M. tuberculosis complex (MTBC) lineages 1, 2, 3, and 4, with the most isolates grouping into lineage 4. Possible transmission pairs containing ≤12 SNPs were identified in lineages 1, 3, and 4 with the prevailing transmission in lineages 3 and 4. Furthermore, investigating DNA codon changes as a result of specific SNPs in prominent virulence genes including plcA and plcB could indicate potentially important modifications in protein function. Incorporating this analysis with corresponding epidemiological data may provide a blueprint for the integration of public health interventions to decrease TB transmission in a region.
Identifiers:
Authors:
Bruce J Kirenga , author
Willy Ssengooba , author
Catherine Muwonge , author
Lydia Nakiyingi , author
Stephen Kyaligonza , author
Samuel Kasozi , author
Frank Mugabe , author
Martin Boeree , author
Moses Joloba , author
Alphonse Okwera , author
Date:
2015-01-01
Journal:
BMC Public Health
Content:
Identifiers:
Authors:
Date:
2021-06-01
Journal:
BMC infectious diseases
Content:

Background

In resource-limited settings, sputum smear conversion is used to document treatment response. Many People living with HIV (PLHIV) are smear-negative at baseline. The Xpert MTB/RIF test can indirectly measure bacterial load through cycle threshold (ct) values. This study aimed to determine if baseline Xpert MTB/RIF could predict time to culture negativity in PLHIV with newly diagnosed TB.

Methods

A subset of 138 PLHIV from the 'SOUTH' study on outcomes related to TB and antiretroviral drug concentrations were included. Bacterial load was estimated by Mycobacterium Growth Indicator Tubes (MGIT) culture time-to-positivity (TTP) and Lowenstein Jensen (LJ) colony counts. Changes in TTP and colony counts were analyzed with Poisson Generalised Estimating Equations (GEE) and multilevel ordered logistic regression models, respectively, while time to culture negativity analysed with Cox proportional hazard models. ROC curves were used to explore the accuracy of the ct value in predicting culture negativity.

Results

A total of 81 patients (58.7%) were males, median age 34 (IQR 29  ̶ 40) years, median CD4 cell count of 180 (IQR 68  ̶ 345) cells/μL and 77.5% were ART naive. The median baseline ct value was 25.1 (IQR 21.0  ̶ 30.1). A unit Increase in the ct value was associated with a 5% (IRR = 1.05 95% CI 1.04  ̶ 1.06) and 3% (IRR = 1.03 95% CI 1.03  ̶ 1.04) increase in TTP at week 2 and 4 respectively. With LJ culture, a patient's colony grade was reduced by 0.86 times (0R = 0.86 95% CI 0.74  ̶ 0.97) at week 2 and 0.84 times (OR = 0.84 95% CI 0.79  ̶ 0.95 P = 0.002) at week 4 for every unit increase in the baseline ct value. There was a 3% higher likelihood of earlier conversion to negativity for every unit increase in the ct value. A ct cut point ≥28 best predicted culture negativity at week 4 with a sensitivity of 91. 7% & specificity 53.7% while a cut point ≥23 best predicted culture negativity at week 8.

Conclusion

Baseline Xpert MTB/RIF ct values predict sputum conversion in PLHIV on anti-TB treatment. Surrogate biomarkers for sputum conversion in PLHIV are still a research priority.
Identifiers:
Authors:
Date:
2021-01-13
Journal:
BMC infectious diseases
Content:

Background

Chest X-ray (CXR) interpretation remains a central component of the current World Health Organization recommendations as an adjuvant test in diagnosis of smear-negative tuberculosis (TB). With its low specificity, high maintenance and operational costs, utility of CXR in diagnosis of smear-negative TB in high HIV/TB burden settings in the Xpert MTB/RIF era remains unpredictable. We evaluated accuracy and additive value of CXR to Xpert MTB/RIF in the diagnosis of TB among HIV-positive smear-negative presumptive TB patients.

Methods

HIV co-infected presumptive TB patients were recruited from the Infectious Diseases Institute outpatient clinic and in-patient medical wards of Mulago Hospital, Uganda. CXR films were reviewed by two independent radiologists using a standardized evaluation form. CXR interpretation with regard to TB was either positive (consistent with TB) or negative (normal or unlikely TB). Sensitivity, specificity and predictive values of CXR and CXR combined with Xpert MTB/RIF for diagnosis of smear-negative TB in HIV-positive patients were calculated using sputum and/or blood mycobacterial culture as reference standard.

Results

Three hundred sixty-six HIV co-infected smear-negative participants (female, 63.4%; hospitalized, 68.3%) had technically interpretable CXR. Median (IQR) age was 32 (28-39) years and CD4 count 112 (23-308) cells/mm3. Overall, 22% (81/366) were positive for Mycobacterium tuberculosis (Mtb) on culture; 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 diagnosis of culture-positive TB 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 MTB/RIF had overall sensitivity and specificity of 87.7% (95%CI 78.5-93.9) and 51.6% (95%CI 45.6-57.5) respectively; 86.2% (95%CI 75.3-93.5) and 48.1% (95%CI 40.7-55.6) among inpatients and 93.8% (95%CI 69.8-99.8) and 58.0% (95%CI 47.7-67.8) among outpatients respectively.

Conclusion

In this high prevalence TB/HIV setting, CXR interpretation added sensitivity to Xpert MTB/RIF test at the expense of specificity in the diagnosis of culture-positive TB in HIV-positive individuals presenting with TB symptoms and negative smear. CXR interpretation may not add diagnostic value in settings where Xpert MTB/RIF is available as a TB diagnostic tool.
Identifiers:
Authors:
Stucki, D.
Brites, D.
Jeljeli, L.
Coscolla, M.
Liu, Q.
Trauner, A.
Fenner, L.
Rutaihwa, L.
Borrell, S.
Luo, T.
Gao, Q.
Kato-Maeda, M.
Ballif, M.
Egger, M.
Macedo, R.
Mardassi, H.
Moreno, M.
Vilanova, G.T.
Fyfe, J.
Globan, M.
Thomas, J.
Jamieson, F.
Guthrie, J.L.
Asante-Poku, A.
Yeboah-Manu, D.
Wampande, E.
Ssengooba, W.
Joloba, M.
Boom, W.H.
Basu, I.
Bower, J.
Saraiva, M.
Vasconcellos, S.E.G.
Suffys, P.
Koch, A.
Wilkinson, R.
Gail-Bekker, L.
Malla, B.
Ley, S.D.
Beck, H.-P.
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Open forum infectious diseases
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Background

The Global Laboratory Initiative (GLI) guidelines recommend repeat for GeneXpertMTB/RIF (XpertMTB/RIF) in patients with a low pretest probability of rifampicin resistance (RR).

Methods

This was a cross-sectional study using results of sputum specimens collected from participants screened for the STREAM 2 trial. We recruited all patients with XpertMTB/RIF RR-TB detected who were referred for RR/multidrug-resistant (MDR) TB treatment initiation at Mulago National Referral Hospital, Kampala, between September 2017 and October 2019. At baseline, smear microscopy, repeat XpertMTB/RIF, Xpert Ultra, and MTBDRplus assays were done on sputum specimens. Culture-based drug susceptibility testing (DST) was performed on discordant specimens. We analyzed the prevalence and factors associated with discordance between initial and repeat XpertMTB/RIF RR and false XpertMTB/RIF RR. False XpertMTB/RIF RR was defined as no RR detected by any of Xpert Ultra, LPA, or culture DST (reference comparator).

Results

A total of 126/130 patients had repeat XpertMTB/RIF results, of whom 97 (77.0%) had M. tuberculosis detected, 81 (83.5%) had RR detected, and 1 (1.0%) had RR indeterminate. The prevalence of discordant XpertMTB/RIF RR was 15/96 (15.6%), whereas false XpertMTB/RIF RR prevalence was 10/96 (10.4%).Low-bacillary load sputum specimens were more likely to have discordant XpertMTB/RIF RR and false XpertMTB/RIF RR results (adjusted odds ratio [aOR], 0.04; 95% CI, 0.00-0.37; P = .01; aOR, 0.02; 95% CI, 0.01-0.35; P = .01, respectively).

Conclusions

Our findings show a high false-positive rifampicin resistance rate in low-TB burden patients, which calls for repeat testing in order to prevent unnecessary prescription of anti-MDR-TB therapy.
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