Evidence map›Paper›PMID 30059995›Full record

Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019

Screening for Tuberculosis With Xpert MTB/RIF Assay Versus Fluorescent Microscopy Among Adults Newly Diagnosed With Human Immunodeficiency Virus in Rural Malawi: A Cluster Randomized Trial (Chepetsa).

Lucky G Ngwira, Elizabeth L Corbett, McEwen Khundi, Grace L Barnes, Austin Nkhoma, Michael Murowa, Silvia Cohn, Lawrence H Moulton, Richard E Chaisson, David W Dowdy

Registry-linked trialOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01450085 (Impact of a New Molecular Tuberculosis), which is not on this map. Cited by 17 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 7 pooled it
2.7field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01450085 nacompletednot on this map

Impact of a New Molecular Tuberculosis (TB) Test on TB/HIV Outcomes Among HIV-

TypeinterventionalSponsorJohns Hopkins UniversityRan2012 to 2016Enrolled1,200ConditionsTuberculosisArmsGeneXpert, LED Microscopy
3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 7 syntheses or guidelines pooled it, 29 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. A systematic review of the number needed to screen for active TB among people living with HIV.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2021
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Trial
  9. Trial
  10. Trial
  11. Article
  12. Article
  13. Article
  14. Health-related quality of life of inpatients and outpatients with TB in rural Malawi.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2020
    Article
  15. Article
  16. Patient-incurred cost of inpatient treatment for Tuberculosis in rural Malawi.Tropical medicine & international health : TM & IH · 2020
    Article
  17. Xpert at 8 years: where are we now, and what should we do next?The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 3 countries.

Lucky G NgwiraHIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre.
Elizabeth L CorbettHIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre.
McEwen KhundiHIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre.
Grace L BarnesCenter for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Austin NkhomaHIV and TB Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre.
Michael MurowaMalawi Ministry of Health, Lilongwe, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Silvia CohnCenter for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Lawrence H MoultonCenter for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Richard E ChaissonCenter for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
David W DowdyCenter for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Medicine · USUniversity of Liverpool · GBJohns Hopkins University · USMalawi-Liverpool-Wellcome Trust Clinical Research Programme · MWMinistry of Health · MW

Funding

Vaccine Response and Immunotherapeutics SWGP30AI094189 · NIAID · JOHNS HOPKINS UNIVERSITY · PI Richard E. Chaisson · 2012 to 2026
$67.0M
Impact of a New Molecular TB Test on TB/HIV Outcomes among HIV-Infected MalawiansR01AI093316 · NIAID · JOHNS HOPKINS UNIVERSITY · PI CHAISSON, RICHARD E. · 2011 to 2015
$2.8M
NIAID NIH HHS P30 AI094189NIAID NIH HHS R01 AI093316Wellcome Trust 200901/Z/16/ZWellcome Trust WT200901/Z/16/Z
6 · The paper itself

Abstract

backgroundTuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV)-infected individuals globally. Screening for TB at the point of HIV diagnosis with a high-sensitivity assay presents an opportunity to reduce mortality.

methodsWe performed a cluster randomized trial of TB screening among adults newly diagnosed with HIV in 12 primary health clinics in rural Thyolo, Malawi. Clinics were allocated in a 1:1 ratio to perform either point-of-care Xpert MTB/RIF assay (Xpert) or point-of-care light-emitting diode fluorescence microscopy (LED-FM) for individuals screening positive for TB symptoms. Asymptomatic participants were offered isoniazid preventive therapy in both arms. Investigators, but not clinic staff or participants, were masked to allocation. Our primary outcome was the incidence rate ratio (RR) of all-cause mortality within 12 months of HIV diagnosis.

resultsPrevalent TB was diagnosed in 24 of 1001 (2.4%) individuals enrolled in clinics randomized to Xpert, compared with 10 of 841 (1.2%) in clinics randomized to LED-FM. All-cause mortality was 22% lower in the Xpert arm than in the LED-FM arm (6.7 vs 8.6 per 100 person-years; RR, 0.78 [95% confidence interval {CI}, .58-1.06]). A planned subgroup analysis suggested that participants with more advanced HIV (World Health Organization clinical stage 3 or 4) disease had lower mortality in clinics randomized to Xpert than to LED-FM (RR, 0.43 [95% CI, .22-.87]).

conclusionsIn rural Malawi, using point-of-care Xpert MTB/RIF to test symptomatic patients for TB at the time of HIV diagnosis reduced all-cause 12-month mortality among individuals with advanced HIV. CLINICAL TRIALS REGISTRATION: NCT01450085.

Indexed as

AdolescentAdultAgedAged, 80 and overFemaleHIV InfectionsHumansIncidenceMalawiMaleMass ScreeningMicroscopy, FluorescenceMiddle AgedMolecular Diagnostic TechniquesRural PopulationSensitivity and SpecificitydiagnosisHIVMalawirandomized controlled trialtuberculosis

Identifiers

PMID30059995
PMCPMC6769397
OpenAlexW2759439196

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.