The use of lateral flow lipoarabinomannan for diagnosis of TB in advanced HIV disease in Abia State, Nigeria

Abstract

Background: Lateral flow lipoarabinomannan (LF-LAM) test used in the diagnosis of active tuberculosis (TB) among patients with advanced human immunodeficiency virus (HIV) disease remains a relatively new approach in the diagnosis of TB in Nigeria. This study focused on the use of LF-LAM assay Alere Determine™ in the diagnosis of active tuberculosis among patients with advanced HIV disease in Abia State.

Aim: This study was carried out to identify potential gaps that could be missed along the LF-LAM implementation cascade, which can be strengthened to improve quality of patients’ care, while gaining insight into health workers’ understanding of the test.

Setting: This study was carried out in Abia State, Nigeria.

Methods: Electronic data were extracted through a query run on health facility electronic databases, while manual chart abstraction was performed in facilities without and incomplete electronic medical records. In addition, qualitative interviews were conducted among health workers to gain insight.

Results: Out of 1249 newly enrolled patients who were eligible for the test, only 605 (48.4%) were tested, and 644 (51.6%) were missed within the study period (October 2022 – September 2023). Out of this number, 159 (26.3%) were positive for the test, and only 68 (42%) were sent for further testing with GeneXpert, while 30 (18.9%) had no testing with GeneXpert and 61 (38.9%) had no documentation.

Conclusion: Low awareness and capacity among health workers including poor documentation practices contributed to missed opportunities for the patients who could have benefitted from this test.

Contribution: The study recommends comprehensive training of healthcare workers on the utilisation of LF-LAM test and improvement of documentation practices in Abia State and Nigeria.