Malawi tests urine for TB, hopes for a faster diagnosis

A  study conducted last year in South Africa, Tanzania, Zambia, and Zimbabwe concluded that using the lipoarabinomannan (LAM) urine test reduced the tuberculosis death rate in hospital patients with advanced HIV by almost 20 percent. When the urine test was used, patients were started on TB treatment earlier, and this is believed to have contributed to the drop in the mortality rate.

The LAM urine test, which involves placing a few drops of urine onto a test strip and waiting for a specific indicator to appear, allows doctors to diagnose a seriously ill HIV patient with tuberculosis in just 25 minutes.

No special laboratories or technicians are required to administer the test, and each test costs about K2000 (US$2.50).

The test, which at the moment is being done in Zomba, the country’s old capital city, has already seen over 1,300 people diagnosed with HIV enrolled at Zomba Central Hospital.

They were aged above 18, in need of acute admission to the hospital’s medical wards provided informed consent and lived within Zomba and not intending to move away during follow up periods.

Dr Bwanali Jereni, head of the medical department at Zomba hospital, while confirming commencement of the test, said since the trial started there has been improved management of patients with HIV related infections, especially those with TB.

“Generally there has been an increase in the number of patients diagnosed with TB and those put on treatment,” he said.

Jereni said studies have shown that with sputum microscopy and gene expert for TB screening diagnostic yield is at 30 percent.

“This means 70 percent of suspected TB patients are left undiagnosed because sputum specimen submission from patients who do not have a productive cough like most of HIV patients is quite a challenge,” he said.

In Malawi, almost 16,960 TB cases were reported in 2016 down from 17.053 in 2015.

National Tuberculosis Control programme coordinator, Dr James Mpunga, said 53 percent of these TB patients were also infected with HIV.

Mpunga said late presentation of TB in all patients is associated with relatively poor treatment outcomes, adding that this is worse for HIV positive patients who might have compromised immunity levels.

The move to start this test comes barely a year after the World Health Organisation (WHO) Director of the Global TB Programme, Mario Raviglione, stressed the need for Malawi to expand TB interventions to reduce high incidence of the disease.

“Malawi is one of the developing countries where the TB epidemic is a major concern and it is closely associated with HIV and AIDS,” he said.

According to WHO, tuberculosis is the leading killer of HIV-infected people – in 2015, one in three HIV deaths was because of tuberculosis. WHO figures show that 300,000 of the 360,000 HIV-infected people who died of tuberculosis in 2013, were from Africa.

Almost 70 percent of the world’s new HIV infections occur in sub-Saharan Africa.

Source: The Southern Times