Uptake of urine lipoarabinomannan and associated factors in diagnosis of tuberculosis among patients with advanced HIV disease in selected Kampala Capital City Authority HIV clinics

Abstract

Background: Despite tuberculosis (TB) being the leading cause of death and hospitalization among people living with HIV (PLHIV), its diagnosis among this patient population remains a challenge leading to missed opportunities in improving the quality of care and patient survival. World Health Organisation (WHO) has recommended the use of lateral flow urine TB lipoarabinomannan (LF urine TB LAM) to assist in the diagnosis of active TB in both in and outpatient settings for persons with advanced HIV disease since 2019. However, there is a paucity of data on the uptake and factors associated with the use of this life-saving test by health workers among patients with advanced HIV disease. Objective: To determine the proportion of persons with advanced HIV disease who were tested for TB using LF urine TB LAM and factors associated with the use of LF urine TB LAM for TB diagnosis among PLHIV with advanced HIV disease. Methods: Throughout July 2022, a retrospective chart review that systematically enrolled persons with advanced HIV disease (CD4 count <200cells or WHO clinical stage 3 or 4) who attended HIV clinics at Kisenyi HC IV, Kawaala HC IV, and Komamboga HC III from January 2020 to June 2021 was conducted. Participants who were diagnosed with TB using another mode of diagnosis were excluded. A case record form was used to extract socio-demographics, medical history, and health worker level of qualification. The proportion of persons with advanced HIV disease who had a urine TB LAM done and factors associated with the use of this test were determined. Urine LAM uptake was defined as testing for TB using LF urine TB LAM among persons with advanced HIV disease. Results: A total of 301 participants, with a median age of 35(IQR: 29,44) years were enrolled. The majority (55.8%) were males, more than half (62%) were on cotrimoxazole prophylaxis and more than two-thirds (73.1%) were not on antiretroviral therapy. The uptake of LF urine TB LAM among persons with advanced HIV disease was 90.0%, the testing yield was 67%, and anti-TB treatment coverage was 91.8%. Attending Kisenyi HC IV (aPR 1.3, p=0.039) and the use of cotrimoxazole prophylaxis (aPR 1.1, p=0.014) was associated with uptake of LF urine TB LAM. Conclusions: The uptake of LF urine TB LAM among persons with advanced HIV disease in the selected KCCA HIV clinics was high at 90%. There was a statistically significant association between uptake of LF urine TB LAM and attending Kisenyi HC IV, and being on cotrimoxazole prophylaxis. Recommendations: These findings support use of Kisenyi HC IV as a model health centre for exemplary LF urine TB LAM testing services for other public health centres. Furthermore findings from this study would be triangulated by qualitative studies to understand why the KCCA HIV clinics are doing well compared to what was reported by the Ministry of Health. Keywords: Tuberculosis, LF urine TB LAM, Advanced HIV disease