Point-of-Care Urine Lipoarabinomannan Testing to Guide Tuberculosis Treatment Among Severely Ill Inpatients With Human Immunodeficiency Virus in Real-World Practice: A Multicenter Stepped Wedge Cluster-Randomized Trial From Ghana

Åhsberg, Johanna; Puplampu, Peter; Kwashie, Augustine; Commey, J. O. O.; Ganu, Vincent; Omari, Michael Amo; Adusi-Poku, Yaw; Andersen, Aase Bengaard; Kenu, Ernest; Lartey, Margaret; Johansen, Işik Somuncu; Bjerrum, Stephanie

doi:10.1093/cid/ciad316

Cited by 1 publication

(10 citation statements)

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“…This is a two-phase, explanatory sequential mixed methods study (16,17) using an approach where the HCW survey, qualitative in-depth interviews (IDIs), and focus group discussions (FGDs) were nested into the TBPOC study (Figure 1). As described in detail before, the TBPOC study is an open-label multi-center stepped wedge cluster-randomized trial evaluating the impact of the Determine LAM test on timely TB investigation, diagnosis, and treatment among severely ill PHW on admission 1 (15). In the first phase, an HCW survey was performed at three hospitals between January 2021 and January 2022 to address the Determine LAM feasibility and ease of use.…”

Section: Methodsmentioning

confidence: 99%

“…included the collection of qualitative data from FGDs and IDIs to provide an in-depth understanding of the user perspectives and the context for Determine LAM uptake and use. Data integration of the TBPOC study (15,18), HCW survey, and the FGD and IDI occurred at the methods level and the analysis and interpretation level (Figure 2; Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…The study sites and the routine TB diagnostic care cascade are described previously (15,18). Sites include Lekma Hospital (LH), Tema General Hospital (TGH), and Korle Bu Teaching Hospital The mixed methods study nested into the stepped wedge cluster-randomized trial implementing the Determine LAM test at three hospitals in Ghana.…”

Section: Study Sites and Context For Determine Lam Test Implementationmentioning

confidence: 99%

“…In a multi-center stepped wedge cluster-randomized Determine LAM intervention study (TBPOC study), the Determine LAM test was made available for use among severely ill inpatients with HIV admitted at three hospitals in Ghana (15). The intervention was strengthened by training and performance feedback among the healthcare workers (HCWs) involved in patient care at the study sites.…”

Section: Introductionmentioning

confidence: 99%

“…In the Determine LAM intervention study, patients were severely immunosuppressed with a high rate of TB symptoms, but less than half of patients had a routine sputum-based test for TB. When the Determine LAM test was made available, the TB diagnostic yield and the probability of TB treatment initiation increased (15). However, while test uptake among HCWs was high, only half of Determine LAM-positive patients were initiated TB treatment.…”

Section: Introductionmentioning

confidence: 99%

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Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study

Åhsberg,

Tersbøl,

Puplampu

et al. 2024

Front. Public Health

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BackgroundThe urine Determine LAM test has the potential to identify tuberculosis (TB) and reduce early mortality among people living with HIV. However, implementation of the test in practice has been slow. We aimed to understand how a Determine LAM intervention was received and worked in a Ghanaian in-hospital context.Design/MethodsNested in a Determine LAM intervention study, we conducted a two-phase explanatory sequential mixed methods study at three hospitals in Ghana between January 2021 and January 2022. We performed a quantitative survey with 81 healthcare workers (HCWs), four qualitative focus-group discussions with 18 HCWs, and 15 in-depth HCW interviews. Integration was performed at the methods and analysis level. Descriptive analysis, qualitative directed content analysis, and mixed methods joint display were used.ResultsThe gap in access to TB testing when relying on sputum GeneXpert MTB/Rif alone was explained by difficulties in obtaining sputum samples and an in-hospital system that relies on relatives. The Determine LAM test procedure was experienced as easy, and most eligible patients received a test. HCWs expressed that immediate access to Determine LAM tests empowered them in rapid diagnosis. The HCW survey confirmed that bedside was the most common place for Determine LAM testing, but qualitative interviews with nurses revealed concerns about patient confidentiality when performing and disclosing the test results at the bedside. Less than half of Determine LAM-positive patients were initiated on TB treatment, and qualitative data identified a weak link in the communication of the Determine LAM results. Moreover, HCWs were reluctant to initiate Determine LAM-positive patients on TB treatment due to test specificity concerns. The Determine LAM intervention did not have an impact on the time to TB treatment as expected, but patients were, in general, initiated on TB treatment rapidly. We further identified a barrier to accessing TB treatment during weekends and that treatment by tradition is administrated early in the morning.ConclusionThe Determine LAM testing was feasible and empowered HCWs in the management of HIV-associated TB. Important gaps in routine care and Determine LAM-enhanced TB care were often explained by the context. These findings may inform in-hospital quality improvement work and scale-up of Determine LAM in similar settings.

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