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Integrating Tuberculosis and COVID-19 Molecular Testing in Lima, Peru

20 Pages Posted: 27 Jul 2022

See all articles by Emily Lai-Ho MacLean

Emily Lai-Ho MacLean

McGill University - Epidemiology, Biostatistics, & Occupational Health

Luz Villa-Castillo

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt

Patricia Espinoza-Lopez

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt

Tatiana Caceres

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt

Giorgia Sulis

McGill University - Epidemiology, Biostatistics, & Occupational Health

Mikashmi Kohli

the global alliance for diagnostics - FIND

Madhukar Pai

McGill University - Epidemiology, Biostatistics, & Occupational Health

César Ugarte-Gil

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt

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Abstract

Background: Tuberculosis case notifications have plummeted since the COVID-19 pandemic began. Integrated molecular testing could be an opportunity to detect and provide care for both diseases. Many high tuberculosis burden countries have existing GeneXpert networks for tuberculosis testing using Xpert MTB/RIF Ultra (Ultra), and a GeneXpert SARS-CoV-2 assay, Xpert Xpress SARS-CoV-2 (Xpress), is also available. We assessed the feasibility of integrating tuberculosis and COVID-19 testing using one sputum specimen with Ultra and Xpress in Lima, Peru.

Methods: Between February 2021 and April 2022, we recruited adults presenting with clinical symptoms or history suggestive of tuberculosis and/or COVID-19. All participants provided one nasopharyngeal swab (NPS) and one sputum sample. For COVID-19, NPS and sputum were each tested on Xpress and another RT-PCR test; for tuberculosis, sputum was tested using culture and Ultra. Diagnostic accuracy of Xpress-sputum was compared to Xpress-NPS. Individuals with positive Xpress-NPS results were considered COVID-19 positive, while culture-positivity indicated tuberculosis. To assess testing integration, the proportion of cases identified in sputum by Xpress and Ultra were compared to Xpress-NPS and culture, respectively.

Findings: We included 600 participants. In-study prevalence of tuberculosis was 13% (80/600) and for SARS-CoV-2 was 35% (212/600). Among tuberculosis cases, concurrent SARS-CoV-2 positivity ranged from 0% to 14%, depending on the COVID-19 test and specimen used. Regarding integrated testing’s diagnostic yield, Ultra detected 96% of culture-confirmed tuberculosis cases, while Xpress-sputum detected 67% of COVID-19 cases identified by Xpress-NPS. Clinical and laboratory staff reported that integrated molecular testing was easy and acceptable.

Interpretation: The diagnostic yield of Xpress on sputum was moderate, but integrated testing for tuberculosis and COVID-19 using GeneXpert was feasible. However, systematic testing for both diseases may not be a worthwhile approach in everyone presenting with presumptive tuberculosis or COVID-19, as concurrently positive cases were rare. Further research may help determine when integrated testing is most worthwhile.

Funding Information: This project was funded by the Canadian Institutes of Health Research and International Development Research Centre (IDRC) [IDRC project #109554].

Declaration of Interests: None to declare.

Ethics Approval Statement: All participants provided written informed consent. This study received ethical approval from the Comité Institucional de Ética en Investigación at Universidad Peruana Cayetano Heredia (UPCH number SIDISI 202931) and the McGill University Health Centre Research Ethics Board. This study was registered in the PRISA repository at Instituto Nacional de Salud in Peru (number EI00000001484).

Keywords: Tuberculosis, SARS CoV2, COVID-19, Global Health, Diagnostics

Suggested Citation

MacLean, Emily Lai-Ho and Villa-Castillo, Luz and Espinoza-Lopez, Patricia and Caceres, Tatiana and Sulis, Giorgia and Kohli, Mikashmi and Pai, Madhukar and Ugarte-Gil, César, Integrating Tuberculosis and COVID-19 Molecular Testing in Lima, Peru. Available at SSRN: https://ssrn.com/abstract=4174292 or http://dx.doi.org/10.2139/ssrn.4174292

Emily Lai-Ho MacLean

McGill University - Epidemiology, Biostatistics, & Occupational Health ( email )

Luz Villa-Castillo

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt ( email )

Patricia Espinoza-Lopez

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt ( email )

Tatiana Caceres

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt ( email )

Giorgia Sulis

McGill University - Epidemiology, Biostatistics, & Occupational Health

Mikashmi Kohli

the global alliance for diagnostics - FIND ( email )

Madhukar Pai

McGill University - Epidemiology, Biostatistics, & Occupational Health ( email )

César Ugarte-Gil (Contact Author)

Universidad Peruana Cayetano Heredia - Instituto de Medicina Tropical Alexander von Humboldt ( email )

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