Constructing confidence: User perspectives on AlereLAM testing for tuberculosis

ABSTRACT: Background: Diagnosing tuberculosis (TB) 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, A...

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Autores principales:	Muthoni Mwaura, Nora Engel
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Point-of-care diagnostics Qualitative methods Lipoarabinomannan TB/HIV Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/bcb0bb8f0d484e678b6c631cb36f5b77
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spelling	oai:doaj.org-article:bcb0bb8f0d484e678b6c631cb36f5b772021-11-30T04:14:05ZConstructing confidence: User perspectives on AlereLAM testing for tuberculosis1201-971210.1016/j.ijid.2021.09.018https://doaj.org/article/bcb0bb8f0d484e678b6c631cb36f5b772021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1201971221007104https://doaj.org/toc/1201-9712ABSTRACT: Background: Diagnosing tuberculosis (TB) 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 World Health Organization-recommended point-of-care (POC) test of this kind, remains underutilized. This study aimed to understand perspectives and experiences of those using AlereLAM. Methods: Fifteen semi-structured interviews were conducted with clinicians, nurses, program officers, laboratory staff, and patient advocates in Uganda, Kenya, and South Africa. Discussed topics included the approach to diagnosing TB, and experiences, perspectives, and country policy of AlereLAM testing. Results: The POC-friendly characteristics of AlereLAM require more 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.Muthoni MwauraNora EngelElsevierarticlePoint-of-care diagnosticsQualitative methodsLipoarabinomannanTB/HIVInfectious and parasitic diseasesRC109-216ENInternational Journal of Infectious Diseases, Vol 112, Iss , Pp 237-242 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Point-of-care diagnostics Qualitative methods Lipoarabinomannan TB/HIV Infectious and parasitic diseases RC109-216
spellingShingle	Point-of-care diagnostics Qualitative methods Lipoarabinomannan TB/HIV Infectious and parasitic diseases RC109-216 Muthoni Mwaura Nora Engel Constructing confidence: User perspectives on AlereLAM testing for tuberculosis
description	ABSTRACT: Background: Diagnosing tuberculosis (TB) 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 World Health Organization-recommended point-of-care (POC) test of this kind, remains underutilized. This study aimed to understand perspectives and experiences of those using AlereLAM. Methods: Fifteen semi-structured interviews were conducted with clinicians, nurses, program officers, laboratory staff, and patient advocates in Uganda, Kenya, and South Africa. Discussed topics included the approach to diagnosing TB, and experiences, perspectives, and country policy of AlereLAM testing. Results: The POC-friendly characteristics of AlereLAM require more 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.
format	article
author	Muthoni Mwaura Nora Engel
author_facet	Muthoni Mwaura Nora Engel
author_sort	Muthoni Mwaura
title	Constructing confidence: User perspectives on AlereLAM testing for tuberculosis
title_short	Constructing confidence: User perspectives on AlereLAM testing for tuberculosis
title_full	Constructing confidence: User perspectives on AlereLAM testing for tuberculosis
title_fullStr	Constructing confidence: User perspectives on AlereLAM testing for tuberculosis
title_full_unstemmed	Constructing confidence: User perspectives on AlereLAM testing for tuberculosis
title_sort	constructing confidence: user perspectives on alerelam testing for tuberculosis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/bcb0bb8f0d484e678b6c631cb36f5b77
work_keys_str_mv	AT muthonimwaura constructingconfidenceuserperspectivesonalerelamtestingfortuberculosis AT noraengel constructingconfidenceuserperspectivesonalerelamtestingfortuberculosis
_version_	1718406828468994048

Constructing confidence: User perspectives on AlereLAM testing for tuberculosis

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