title: Detection of lipoarabinomannan in urine for identification of active tuberculosis among HIV-positive adults in Ethiopian health centres.
abstract: OBJECTIVE
  To assess the diagnostic performance of urine lipoarabinomannan (LAM) detection for TB screening in HIV-positive adults in Ethiopia.
  
  
  METHODS
  Testing for LAM was performed using the Determine TB-LAM lateral flow assay on urine samples from participants in a prospective cohort with baseline bacteriological categorisation for active TB in sputum. Characteristics of TB patients with regard to LAM status were determined. Participants were followed for 6 months to evaluate survival, retention in care and incident TB.
  
  
  RESULTS
  Positive LAM results were found in 78/757 participants. Among 128 subjects with definite (confirmed by culture and/or Xpert MTB/RIF) TB, 33 were LAM-positive (25.8%); the respective figure for clinically diagnosed cases was 2/20 (10%). Five of the remaining 43 LAM-positive individuals had died during the 6-month follow-up period, whereas 38 remained in care without clinical signs of TB. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 25.8%, 92.9%, 42.3% and 86.0%, respectively. Among TB patients, LAM positivity was associated with higher WHO clinical stage, lower body mass index (BMI), CD4 cell and haemoglobin levels, and with increased mortality. A combination algorithm of urine LAM testing and sputum smear microscopy detected 49 (38.2%) of definite TB cases; among those with CD4 count ≤100 cells/mm3, this proportion was 66.7%.
  
  
  CONCLUSIONS
  The performance of urine LAM testing for TB detection was poor in this population. However, this was improved among subjects with CD4 count ≤100 cells/mm3. In combination with sputum microscopy urine, LAM could be considered for targeted TB screening in this subgroup.
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.|Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Taye T
authors.initials: TT
authors.lastname: Balcha
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.|Regional Department of Infectious Disease Control and Prevention, Malmö, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Winqvist
authors.affiliation: Clinical Microbiology, Regional and University Laboratories, Region Skåne, Malmö, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Sturegård
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Sten
authors.initials: S
authors.lastname: Skogmar
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Anton
authors.initials: A
authors.lastname: Reepalu
authors.affiliation: Oromia Regional Health Bureau, Addis Ababa, Ethiopia.
authors.forename: Zelalem H
authors.initials: ZH
authors.lastname: Jemal
authors.affiliation: Columbia University Mailman School of Public Health, International Center for AIDS Care and Treatment Programs- Ethiopia, Addis Ababa, Ethiopia.
authors.forename: Gudeta
authors.initials: G
authors.lastname: Tibesso
authors.affiliation: Department of Medical Microbiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.|Department of Clinical Microbiology and Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schön
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Björkman
keywords: 
  ART
  ; 
  TAR
  ; 
  TB
  ; Determinación TB-LAM; Determine TB-LAM; Ethiopia; Ethiopie; Etiopía; Lipoarabinomanano; antiretroviral therapy; centres de santé; centros sanitarios; determine TB-LAM; health centres; lipoarabinomannan; lipoarabinomannane; tuberculose