RATIONALE The recommended tuberculosis (TB) intensified case finding (ICF) algorithm for people living with HIV (symptom-based screening followed by Xpert MTB/RIF [Xpert] testing) is insufficiently sensitive and results in unnecessary Xpert testing. OBJECTIVES To evaluate whether novel ICF algorithms combining C-reactive protein (CRP)-based screening with urine Determine TB-LAM (TB-LAM), sputum Xpert, and/or sputum culture could improve ICF yield and efficiency. METHODS We compared the yield and efficiency of novel ICF algorithms inclusive of point-of-care CRP-based TB screening and confirmatory testing with urine TB-LAM (if CD4 count ≤100 cells/μl), sputum Xpert, and/or a single sputum culture among consecutive people living with HIV with CD4 counts less than or equal to 350 cells/μl initiating antiretroviral therapy in Uganda. MEASUREMENTS AND MAIN RESULTS Of 1,245 people living with HIV, 203 (16%) had culture-confirmed TB including 101 (49%) patients with CD4 counts less than or equal to 100 cells/μl. Compared with the current ICF algorithm, point-of-care CRP-based TB screening followed by Xpert testing had similar yield (56% [95% confidence interval, 49-63] vs. 59% [95% confidence interval, 51-65]) but consumed less than half as many Xpert assays per TB case detected (9 vs. 4). Addition of TB-LAM did not significantly increase diagnostic yield relative to the current ICF algorithm but provided same-day diagnosis for 26% of TB patients with advanced HIV. Addition of a single culture to TB-LAM and Xpert substantially improved ICF yield, identifying 78% of all TB cases. CONCLUSIONS Point-of-care CRP-based screening can improve ICF efficiency among people living with HIV. Addition of TB-LAM and a single culture to Xpert confirmatory testing could enable HIV programs to increase the speed of TB diagnosis and ICF yield.

中文翻译：

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针对艾滋病毒携带者的新型强化结核病例发现算法的收率和效率。

理由对于HIV感染者（基于症状的筛查，然后进行Xpert MTB / RIF [Xpert]测试），推荐的结核病增强病例发现（ICF）算法敏感性不够，会导致不必要的Xpert测试。目的要评估将基于C反应蛋白（CRP）的筛查与尿液结合起来的新型ICF算法是否可以提高TB-LAM（TB-LAM），痰Xpert和/或痰培养的效率。方法我们比较了新型ICF算法（包括基于即时CRP的TB筛查和确证性测试）与尿液TB-LAM（如果CD4计数≤100个细胞/μl），痰Xpert和/或单个痰液的效率和有效性。在乌干达，连续感染CD4的HIV感染者的痰培养计数小于或等于350细胞/μl，因此开始进行抗逆转录病毒治疗。测量和主要结果在1,245名HIV感染者中，有203名（16％）患有经培养证实的结核病，其中101名（49％）CD4计数小于或等于100细胞/μl的患者。与当前的ICF算法相比，基于即时点CRP的TB筛查和Xpert测试的收率相似（56％[95％置信区间49-63]与59％[95％置信区间51-65 ]），但每检测到的TB病例消耗的Xpert分析不到一半（9比4）。相对于当前的ICF算法，添加TB-LAM并不能显着提高诊断率，但可以为26％的晚期HIV结核病患者提供当天诊断。在TB-LAM和Xpert中添加单一培养物可显着提高ICF产量，在所有TB病例中占78％。结论基于CRP的即时护理筛查可以提高HIV感染者的ICF效率。在Xpert确认测试中添加TB-LAM和单一培养物可以使HIV计划提高TB诊断速度和ICF产量。