Screening for Tuberculosis in HIV-infected Patients Eligible for Antiretroviral Treatment

This study is currently recruiting participants.
Verified October 2012 by Lund University
Swedish International Development Cooperation Agency (SIDA)
Swedish Civil Contingencies Agency (MSB)
Information provided by (Responsible Party):
Per Bjorkman, Lund University Identifier:
First received: September 11, 2011
Last updated: October 20, 2012
Last verified: October 2012

Background: Increased access to antiretroviral therapy (ART) in Africa will require decentralization to primary health care. For this purpose, adapted methods for management of patients co-infected with tuberculosis (TB) and HIV are needed. Improved detection of TB in patients starting ART, and assessment of co-administration of ART and TB treatment are priorities in this field.

Aims: To identify clinical predictors of TB in patients starting ART, and to construct screening algorithms for TB in this population; to assess ART outcomes in patients receiving TB treatment at health centre level.

Work plan: The project is performed in health centres providing ART in Ethiopia. A cohort of HIV positive patients initiating ART will be prospectively followed. Baseline characteristics are registered; blood samples for CD4 cells, HIV RNA and immunological markers are collected, as well as sputum for TB culture and PCR. During ART, clinical data, CD4 cell counts and HIV RNA levels are followed. Patients with TB are compared to those without TB with regard to ART outcome. Baseline factors associated with TB will be used to construct TB screening algorithms.

Significance: These studies give insight into TB-HIV co-infection at primary health care level in a Sub-Saharan region, and may impact future guidelines for management of such patients.

HIV Infection

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Tuberculosis in HIV-infected Patients Managed in Health Centres in Ethiopia - Identification of a Screening Algorithm for Active Tuberculosis and Determination of Outcome of Combined Antituberculosis and Antiretroviral Treatment

Resource links provided by NLM:

Further study details as provided by Lund University:

Primary Outcome Measures:
  • Correlation between baseline clinical characteristics and presence of microbiologically confirmed active tuberculosis. [ Time Frame: Two years ] [ Designated as safety issue: No ]
    To develop an algorithm with the potential to identify indicators of prevalent and incident TB among patients initiating ART by correlating baseline clinical signs and symptoms with results of culture- and PCR-based investigations for TB. Such clinical characteristics will be compared both to TB present before starting ART, as well as to TB presenting during the first year after ART initiation. Results from this comparison will be used to construct an algorithm for TB screening in Ethiopian patients eligible for ART.

  • Comparison of ART outcome in patients taking concomitant anti-tuberculosis therapy and those only taking ART. [ Time Frame: Three years ] [ Designated as safety issue: No ]
    To prospectively compare clinical, immunological and virological outcomes of ART in patients with concomitant ATT to those in patients only receiving ART. Specific aims are to study rates of virological suppression during ART, the development of antiretroviral drug resistance, and treatment adherence.

Secondary Outcome Measures:
  • Comparison of diagnostic methods for detection of TB among HIV-infected subjects eligible to start ART. [ Time Frame: Two years ] [ Designated as safety issue: No ]
    To compare the diagnostic yields of GeneXpert PCR, smear microscopy and novel tests for the detection of TB among HIV-infected subjects in Ethiopia eligible to start ART, using mycobacterial culture as reference.

Biospecimen Retention:   Samples Without DNA

Aliquoted plasma samples from consenting participants will be stored at -80 C for analysis of biomarkers of tuberculosis and for prognostic markers. Stool and urine samples will be stored at -20 C for analysis of alternative biomarkers of active tuberculosis.

Estimated Enrollment: 1000
Study Start Date: October 2011
Estimated Study Completion Date: February 2014
Estimated Primary Completion Date: February 2013 (Final data collection date for primary outcome measure)
Antiretroviral therapy, tuberculosis
Patients eligible for starting ART in health centres in Ethiopia

  Show Detailed Description


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population

HIV-infected patients managed in health centres


Inclusion Criteria:

  • HIV infection
  • Fulfills criteria for antiretroviral therapy (CD4 cell count below 350 cells/ml and/or WHO stage IV)
  • Residence in study uptake area
  • Written informed consent to participation and to tracing in case of defaulting

Exclusion Criteria:

  • Ongoing or previous antiretroviral therapy
  • Treatment for active tuberculosis for more than two weeks
  Contacts and Locations
Please refer to this study by its identifier: NCT01433796

Contact: Per Björkman, M.D., Ph.D. +46768111978
Contact: Taye Tolera Balcha, M.D. +251921609696

Adama Health Centre Recruiting
Adama, Oromia, Ethiopia
Contact: Adanech Adanech, HO         
Contact: Zewditho Zewditho, BSc Nurse         
Principal Investigator: Zewditho Zewditho, BSc Nurse         
Sub-Investigator: Ardanech Ardanech, HO         
Geda Health Centre Recruiting
Adama, Oromia, Ethiopia
Contact: Baharuddin Baharuddin, HO         
Contact: Aragawi Aragawi, HO         
Principal Investigator: Baharuddin Baharuddin, HO         
Sub-Investigator: Liyat Liyat, HO         
Dhera Health Center Recruiting
Dhera, Oromia, Ethiopia
Contact: Khader Khader, Nurse         
Contact: Zelalem Zelalem, Nurse         
Principal Investigator: Zelalem Zelalem, Nurse         
Sub-Investigator: Asenakech Asenakech, Nurse         
Mojo Health Centre Recruiting
Mojo, Oromia, Ethiopia
Contact: Senait Senait, HO         
Contact: Siraj Siraj, Nurse         
Principal Investigator: Senait Senait, HO         
Sub-Investigator: Siraj Siraj, Nurse         
Welenchiti Health Centre Recruiting
Welenchiti, Oromia, Ethiopia
Contact: Mekdies Asseta, HO         
Contact: Birhanu Demissie, HO         
Principal Investigator: Mekies Asseta, HO         
Sub-Investigator: Birhanu Birhanu, HO         
Sponsors and Collaborators
Lund University
Swedish International Development Cooperation Agency (SIDA)
Swedish Civil Contingencies Agency (MSB)
Study Director: Per Björkman, M.D., Ph.D. Lund University
Principal Investigator: Taye Tolera Balcha, M.D. Lund University
Study Chair: Erik Sturegård, M.D., Ph.D. Lund University
  More Information

Boehme CC, Nabeta P, Hillemann D, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 2010; 363: 1005-15
Karim SA, Naidoo K, Grobler A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med 2010; 362: 697-706

Responsible Party: Per Bjorkman, Associate professor, Lund University Identifier: NCT01433796     History of Changes
Other Study ID Numbers: LU-2010/672, 3120/215/03
Study First Received: September 11, 2011
Last Updated: October 20, 2012
Health Authority: Ethiopia: Ethical Review Committee
Sweden: Regional Ethical Review Board

Keywords provided by Lund University:
antiretroviral therapy
health centres

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections processed this record on April 20, 2014