Tuberculosis (TB)

The use of lateral flow urine lipoarabinomannan assay (LF-LAM) for the diagnosis and screening of active tuberculosis in people living with HIV

Policy update

Authors:
WHO

Publication details

Number of pages: 74
Publication date: 2015
Languages: English
ISBN: 978 92 4 150963 3
WHO reference number: WHO/HTM/TB/2015.25

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Background

Tests based on the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine have emerged as potential point-of-care tests for tuberculosis (TB). LAM antigen is a lipopolysaccharide present in mycobacterial cell walls, which is released from metabolically active or degenerating bacterial cells and appears to be present only in people with active TB disease. Urine-based testing would have advantages over sputum-based testing because urine is easy to collect and store, and lacks the infection control risks associated with sputum collection.

Objectives

This document provides a summary of the evidence and recommendations for the use of LF-LAM for the diagnosis and screening of active tuberculosis in people living with HIV.

  • To assess the available data on the accuracy (sensitivity and specificity) of lateral flow urine lipoarabinomannan assay (LF-LAM) for screening and diagnosis of active TB in HIV-infected adults, at different thresholds for test positivity, as a replacement or in combination with other diagnostic tools.
  • To assess the available data on the accuracy (sensitivity and specificity) of lateral flow urine lipoarabinomannan assay (LF-LAM) for diagnosis of active TB in HIV-infected children.
  • To assess data related to patient outcomes, both the association of LAM positivity and patient outcomes and the impact of LAM implementation on patient outcomes in HIV-infected patients, as a replacement or in combination with other diagnostic tools.
  • To assess available data on the cost, and cost-effectiveness of LAM implementation for TB diagnosis or screening of active tuberculosis in people living with HIV compared with sputum microscopy or Xpert MTB/RIF.
  • To develop WHO policy recommendations for the appropriate use of LF-LAM for the diagnosis and screening of active tuberculosis in people living with HIV.