Low tuberculosis treatment initiation after positive tuberculosis lipoarabinomannan results

Urine-based tuberculosis-lipoarabinomannan (TB-LAM) testing can increase the yield of tuberculosis (TB) case finding and TB-treatment initiation when added to commonly used sputum-based TB diagnostics among people living with HIV (PLHIV) [1, 2]. Since 2019 the World Health Organization (WHO) recommends TB-LAM testing in all outpatient PLHIV with TB symptoms, a CD4 below 100 cells/µl, or signs of serious illness [3]. Alere Determine TB-lipoarabinomannan (AlereLAM; Abbott, USA) is the one available TB-LAM test [4]. Guideline implementation and AlereLAM testing uptake are poor. In 2021, 11/25 (44%) surveyed African countries had a TB-LAM policy, but only South Africa (4%) reported widespread facility use [5]. In 2022, 19/22 (86%) surveyed high TB/HIV burden countries had a TB-LAM policy, but only 47% (9/19) reported health facility use [6]. Testing with AlereLAM is only useful if a positive test leads to TB-treatment initiation [3]. Evidence on the effect of a positive AlereLAM result on starting TB treatment is scarce. Footnotes This manuscript has recently been accepted for publication in the ERJ Open Research . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article. Conflict of interest: The authors report no conflicts of interest.