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SMF to Improve Performance of Microscopy for the Diagnosis of PTB in a High HIV Prevalence Setting (PTB)

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ClinicalTrials.gov Identifier: NCT02701439
Recruitment Status : Completed
First Posted : March 8, 2016
Last Update Posted : March 8, 2016
Sponsor:
Collaborators:
Boston University
University of Florida
Information provided by (Responsible Party):
Epicentre

Brief Summary:
This study is investigating a better method to see if someone has tuberculosis (TB) as compared to the method that is being used now.

Condition or disease Intervention/treatment
Tuberculosis Device: Small membrane filtration

Detailed Description:

TB is a disease caused by a bacterium called Mycobacterium tuberculosis that can affect the lungs or other parts of the body. In most of the world and in Mbarara, Uganda, the method of diagnosis that is used is AFB smear microscopy. This method is widely available, inexpensive and rapid. However, this method's ability to truly detect people having TB is poor. That is, if someone has TB, the test results may say that they are negative, leading to delays in diagnosis, disease progression, and an ongoing transmission of the bacteria.

The new test for TB diagnosis we are studying is called the Small Membrane Filtration (SMF) method. This test that is being compared to the method currently being used and is very similar to the one that is currently used (standard smear microscopy) but has the advantage of concentrating the sputum (mucus) so that we can more easily see if bacteria are present in the sputum. It is hoped that a better way of knowing if someone has TB will help doctors decide when people need to be treated for TB and when not, which will improve the health of patients and help avoid passing the infection to others.

This study will enroll 740 HIV-infected and 310 HIV-uninfected adults with culture confirmed pulmonary TB. These individuals will be identified prospectively at two TB clinics in Mbarara, Uganda.

Study hypothesis: The investigators will assume that one sputum sample will be equivalent to two (null hypothesis) with respect to sensitivity unless we have evidence that the use of two has higher sensitivity (alternative hypothesis). The investigators will assume that SMF is equivalent to AFB smear with respect to sensitivity and specificity unless the investigators find evidence it is superior. The investigators will assume that SMF is equivalent to Xpert unless the investigators find evidence that Xpert is superior.


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Study Type : Observational
Actual Enrollment : 1050 participants
Time Perspective: Cross-Sectional
Official Title: Small Membrane Filtration (SMF) Method to Improve the Performance of Smear Microscopy for the Diagnosis of Pulmonary Tuberculosis in a High HIV Prevalence Setting
Study Start Date : September 2012
Actual Primary Completion Date : June 2014
Actual Study Completion Date : June 2014

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
HIV-infected

Enrollment of 740 HIV-infected adults with suspicion of pulmonary TB.

Following the Ugandan National Tuberculosis and Leprosy Programme (NTLP) guidelines, all enrolled TB suspects will undergo the following standardized evaluation:

  • Abbreviated demographic and clinical evaluation
  • TB history and evaluation
  • Obtain three sputum samples - one early morning sample and two spot samples
  • HIV testing (and CD4 if positive)
  • Chest radiograph
  • Small membrane filtration intervention
Device: Small membrane filtration

Following the Ugandan National Tuberculosis and Leprosy Programme (NTLP) guidelines, all enrolled TB suspects will undergo the following standardized evaluation:

  • Abbreviated demographic and clinical evaluation
  • TB history and evaluation
  • Obtain three sputum samples - one early morning sample and two spot samples
  • HIV testing (and CD4 if positive)
  • Chest radiograph
  • Small membrane filtration intervention will be administered to both arms

HIV negative

Enrollment of 350 HIV negative adults with suspicion of pulmonary TB.

Following the Ugandan National Tuberculosis and Leprosy Programme (NTLP) guidelines, all enrolled TB suspects will undergo the following standardized evaluation:

  • Abbreviated demographic and clinical evaluation
  • TB history and evaluation
  • Obtain three sputum samples - one early morning sample and two spot samples
  • HIV testing (and CD4 if positive)
  • Chest radiograph
  • Small membrane filtration intervention
Device: Small membrane filtration

Following the Ugandan National Tuberculosis and Leprosy Programme (NTLP) guidelines, all enrolled TB suspects will undergo the following standardized evaluation:

  • Abbreviated demographic and clinical evaluation
  • TB history and evaluation
  • Obtain three sputum samples - one early morning sample and two spot samples
  • HIV testing (and CD4 if positive)
  • Chest radiograph
  • Small membrane filtration intervention will be administered to both arms




Primary Outcome Measures :
  1. Sensitivity and specificity of SMF method and Xpert MTB/RIF assay [ Time Frame: 24 months ]
    The primary endpoints of this laboratory-based study will be to determine the sensitivity and specificity of the SMF method and Xpert MTB/RIF assay, using manual MGIT liquid culture as the gold standard


Biospecimen Retention:   Samples With DNA
TB isolates from sputum samples


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Adult patients with a suspected diagnosis of pulmonary TB attending two TB clinics in Mbarara, Uganda
Criteria

Inclusion Criteria:

  • Adult (≥18 years)
  • Pulmonary TB suspect defined as any person who presents with a productive cough for more than 2 weeks AND accompanied by at least one other respiratory symptom (shortness of breath, chest pains, hemoptysis) and/or constitutional symptom (loss of appetite, weight loss, fever, night sweats, and fatigue) (6).
  • Willing to undergo TB evaluation and spontaneously expectorate ≥2 mL of sputum
  • Willing to be tested for HIV, if no results available within past 6 months

Exclusion Criteria:

  • Too ill or unable to provide written consent
  • Treated with TB drugs for more than 3 days
  • Extra-pulmonary or disseminated TB without pulmonary involvement (i.e. no cough)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02701439


Locations
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Uganda
Epicentre Mbarara Research Base
Mbarara, Uganda, 1956
Sponsors and Collaborators
Epicentre
Boston University
University of Florida
Investigators
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Principal Investigator: Yap Boum II, PhD Epicentre

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Responsible Party: Epicentre
ClinicalTrials.gov Identifier: NCT02701439     History of Changes
Other Study ID Numbers: SMF-01
First Posted: March 8, 2016    Key Record Dates
Last Update Posted: March 8, 2016
Last Verified: February 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Additional relevant MeSH terms:
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Tuberculosis
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections