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New TB screening methods cut deaths in people with HIV

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Ankur GuptaScreening for tuberculosis (TB) and intensified follow-up of TB cases in people starting antiretroviral therapy and urine-based screening of inpatients with HIV both have the potential to significantly reduce deaths and improve rates of TB treatment in people with HIV, according to results of two large studies presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2018) on Monday in Boston.


Despite the introduction of earlier antiretroviral therapy (ART) and wider access to treatment in lower- and middle-income countries, people with HIV in countries with a high burden of TB still have a higher risk of dying of TB after starting antiretroviral treatment than HIV-negative people.


Diagnosing TB in people with HIV who have started ART remains a high priority for reducing deaths and serious illness among people with HIV and for limiting the onward transmission of TB. Screening to exclude active infection is also important so that people without an active infection can be given isoniazid preventive treatment.


Over the past ten years World Health Organization (WHO) recommendations have sought to improve TB case finding among people with HIV. WHO developed a symptom screen for TB to enable cases of active TB to be identified. WHO has also recommended the integration of the Xpert molecular diagnostic platform into screening protocols, to speed up diagnosis.


Another diagnostic tool with a more limited application, a urine-based lipoarabinomannan (LAM) test, was recommended on a conditional basis for use in people with HIV with advanced HIV disease (a CD4 cell count below 100 cells/mm3) or seriously ill patients at any CD4 cell count. WHO concluded that urine-based LAM was not suitable for use as a general screening tool, either in people with HIV or other groups.


Two studies presented at the 2018 CROI showed that innovations in TB case finding and screening reduced mortality in people on ART. The XPRES study in Botswana found that a package of measures to intensify case finding reduced mortality, while the STAMP trial in South Africa and Malawi confirmed that urine-based LAM screening improved TB diagnosis and treatment, and reduced mortality in people on ART who had been admitted to hospital.

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Malaria Group Members Attend LINK Project

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Dr. Anja Terlouw, Alinane Munyenyembe, Chris Jones and Chimwemwe Ligomba, members of the malaria group at MLW, recently attended the Annual Malaria Review Conference that took place in Lilongwe at the Riverside Hotel on the 13th and 14th of February 2018.


The Conference was hosted by the Malawi National Malaria Control Program (NMCP). The aim of the conference was to disseminate the new malaria strategic plan for 2017 - 2022 to all NMCP partners and stakeholders and to review activities of the previous year. Part of the conference agenda was the introduction of the LINK Project which Dr Anja Terlouw is the principal investigator for MLW.


LINK is a collaboration between the London School of Hygiene and Tropical Medicine (LSHTM) and the KEMRI-Wellcome Trust Research Program (KWTRP). The main aim of this project is to strengthen the use of malaria data for decision making in Malawi. The project will assemble and present data in the form of a comprehensive epidemiological profile. Through the production of this profile in combination with strategic engagement with the Malawi national malaria programme, LINK will support the Malawi ministry of health to use local data to target resources for malaria control and prevention where they are most needed.

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Malaria Group’s James Chirombo to Attend IDM’S 6th Symposium

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James ChiromboJames Chirombo, a PhD student in the malaria group will attend the Institute for Disease Modelling (IDM) 6th annual disease modelling symposium to be held from 16-18 April 2018 in Seattle, Washington, USA. James will present part of his PhD work on the spatio-temporal modelling of malaria incidence and climate interactions in Malawi.

 

As an institute, IDM focuses on the development of mathematical and statistical modelling tools to support disease eradication programmes and other global health endeavours. This year’s symposium theme is software accelerating research. Many of the talks will focus on various software modelling tools and algorithms which can help address difficult epidemiological questions.