Summary
Background
Diagnosing tuberculosis in people living with HIV (PLHIV) is challenging due to atypical clinical and radiological presentation and higher rates of sputum negative or extrapulmonary disease. Urine LAM is a promising diagnostic biomarker to address these challenges. Yet, AlereLAM, a WHO recommended point-of-care test of this kind, remains underutilized. This study aimed to understand perspectives and experiences of those using AlereLAM.
Methods
We conducted 15 semi-structured interviews with clinicians, nurses, programme officers, laboratory staff, and patient advocates in Uganda, Kenya and South Africa. Topics discussed included approach to diagnosing tuberculosis and experiences, perspectives and country policy of AlereLAM testing.
Results
The POC-friendly characteristics of AlereLAM need work to be realized. Although limited by relatively low sensitivity and specificity, AlereLAM has important value for identifying TB in people with advanced HIV disease, especially when the environment enables constructing confidence in the test. The initial communication about the low performance by global agencies, restrictive eligibility criteria, reliance on CD4+ testing and lack of advocacy and awareness were noted as reasons for its slow uptake.
Conclusion
The work of operationalizing diagnostics including constructing confidence is important to consider for policymakers, implementers and funders when assessing acceptability, feasibility and scale-up of a diagnostic.
