Multicentre accuracy trial of FUJIFILM SILVAMP TB LAM test in people with HIV reveals lot variability. Székely, R., Sossen, B., Mukoka, M., Muyoyeta, M., Nakabugo, E., Hella, J., Nguyen, H. V., Ubolyam, S., Chikamatsu, K., Macé, A., Vermeulen, M., Centner, C. M, Nyangu, S., Sanjase, N., Sasamalo, M., Dinh, H. T., Ngo, A., Manosuthi, W., Jirajariyavej, S., Mitarai, S., Nguyen, V. N., Avihingsanon, A., Reither, K., Nakiyingi, L., Kerkhoff, A. D, Macpherson, P., Meintjes, G. A, Denkinger, C. M, & Ruhwald, M. medRxiv, Cold Spring Harbor Laboratory Press, sep, 2022.
Multicentre accuracy trial of FUJIFILM SILVAMP TB LAM test in people with HIV reveals lot variability [link]Paper  doi  abstract   bibtex   
Rationale There is an urgent need for rapid, non-sputum point-of-care diagnostics to detect tuberculosis. Objectives This prospective trial in seven high tuberculosis burden countries set out to evaluate the diagnostic accuracy of the point-of-care urine-based lipoarabinomannan assay FUJIFILM SILVAMP TB LAM (FujiLAM) among inpatient and outpatient people living with HIV. Methods Diagnostic performance of FujiLAM at point of care was assessed among adult people with HIV against a mycobacterial reference standard (sputum culture, blood culture, and Xpert Ultra from urine and sputum at enrollment, and additional sputum culture ≤7 days from enrollment), an extended mycobacterial reference standard including available non-study test results, and a composite reference standard including clinical evaluation. Measurements and Main Results: Of 1624 participants enrolled, 294 (18.0%) were classified as TB positive by extended mycobacterial reference standard. Median age was 40 years, median CD4 cell count was 372 cells/ul, 52% were female and 78% were taking antiretroviral therapy at enrollment. Overall FujiLAM sensitivity was 54.8% (95% CI: 49.1-60.4), and overall specificity was 85.1% (83.1-86.9), against the extended mycobacterial reference standard. Sensitivity and specificity estimates varied between sites, ranging from 26.5% (95% CI: 17.4%-38.0%) to 83.3% (43.6%-97.0%), and 75.0 (65.0%-82.9%) to 96.5 (92.1%-98.5%), respectively. Post-hoc exploratory analysis identified significant variability in the performance of the six FujiLAM lots used in this study. Conclusions Lot variability limited interpretation of FujiLAM test performance. Although the results with the current version of FujiLAM are too variable for clinical decision-making, the lipoarabinomannan biomarker still holds promise for tuberculosis diagnostics. ### Competing Interest Statement RS, AM, CMD and MR are or were employed by FIND, the global alliance for diagnostics at the time of the study. FIND is a not-for-profit foundation that supports the evaluation of publicly prioritized tuberculosis assays and the implementation of WHO-approved (guidance and prequalification) assays using donor grants. FIND has product evaluation agreements with several private sector companies that design diagnostics for tuberculosis and other diseases. These agreements strictly define FIND's independence and neutrality with regard to these private sector companies. TB reports patents in the field of TB detection and is a shareholder of Avelo Inc. ### Clinical Trial NCT04089423 ### Funding Statement This work was funded by the Global Health Innovative Technology Fund (GHIT Grant Number G2017-207), the KfW (Grant Number 2020 60 457), Commonwealth of Australia represented by the Department of Foreign Affairs and Trade (DFAT Grant Number 70957) and the Netherlands Enterprise Agency (Grant Number PDP15CH14). Graeme Meintjes was supported by the Wellcome Trust (098316, 214321/Z/18/Z, and 203135/Z/16/Z), and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No 64787). Peter MacPherson was funded by Wellcome (206575/Z/17/Z). This research was funded in part by the Wellcome Trust. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committees of UCT Human Research Ethics Committee, Western Cape Government Health Impact Assessment (South Africa); College of Medicine Research Support Centre (Malawi); Biomedical Research Ethics Committee, National Health Research Authority (Zambia); Infectious Disease Institute Scientific review Committee, Mulago Hospital REC, Uganda National Council for Science and Technology (Uganda); Ifakara Health Institute Scientific Committee, Tanzania Medicines and medical Devices Authority, National Institute for Medical Research (Tanzania); National Lung Hospital Ethics Committee, Ministry of Health (Viet Nam); IRB of Faculty of Medicine, Chulalongkorn University, Bangkok Metropolitan Administration Human Research Ethics Committee, Bamrasnaradura Infectious Diseases Institute (Thailand) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Individual, de-identified participant data will be shared, including data dictionaries. Other documents that have been made available include the study protocol and statistical analysis plan. Templates of the informed consent forms may be shared upon request. The data will be available immediately following publication with no end date. The data will be shared with anyone who wishes to access the data. The data will be available for any purpose of analyses. For data, please contact the corresponding author.
@article{Szekely2022,
abstract = {Rationale There is an urgent need for rapid, non-sputum point-of-care diagnostics to detect tuberculosis. Objectives This prospective trial in seven high tuberculosis burden countries set out to evaluate the diagnostic accuracy of the point-of-care urine-based lipoarabinomannan assay FUJIFILM SILVAMP TB LAM (FujiLAM) among inpatient and outpatient people living with HIV. Methods Diagnostic performance of FujiLAM at point of care was assessed among adult people with HIV against a mycobacterial reference standard (sputum culture, blood culture, and Xpert Ultra from urine and sputum at enrollment, and additional sputum culture ≤7 days from enrollment), an extended mycobacterial reference standard including available non-study test results, and a composite reference standard including clinical evaluation. Measurements and Main Results: Of 1624 participants enrolled, 294 (18.0{\%}) were classified as TB positive by extended mycobacterial reference standard. Median age was 40 years, median CD4 cell count was 372 cells/ul, 52{\%} were female and 78{\%} were taking antiretroviral therapy at enrollment. Overall FujiLAM sensitivity was 54.8{\%} (95{\%} CI: 49.1-60.4), and overall specificity was 85.1{\%} (83.1-86.9), against the extended mycobacterial reference standard. Sensitivity and specificity estimates varied between sites, ranging from 26.5{\%} (95{\%} CI: 17.4{\%}-38.0{\%}) to 83.3{\%} (43.6{\%}-97.0{\%}), and 75.0 (65.0{\%}-82.9{\%}) to 96.5 (92.1{\%}-98.5{\%}), respectively. Post-hoc exploratory analysis identified significant variability in the performance of the six FujiLAM lots used in this study. Conclusions Lot variability limited interpretation of FujiLAM test performance. Although the results with the current version of FujiLAM are too variable for clinical decision-making, the lipoarabinomannan biomarker still holds promise for tuberculosis diagnostics. {\#}{\#}{\#} Competing Interest Statement RS, AM, CMD and MR are or were employed by FIND, the global alliance for diagnostics at the time of the study. FIND is a not-for-profit foundation that supports the evaluation of publicly prioritized tuberculosis assays and the implementation of WHO-approved (guidance and prequalification) assays using donor grants. FIND has product evaluation agreements with several private sector companies that design diagnostics for tuberculosis and other diseases. These agreements strictly define FIND's independence and neutrality with regard to these private sector companies. TB reports patents in the field of TB detection and is a shareholder of Avelo Inc. {\#}{\#}{\#} Clinical Trial NCT04089423 {\#}{\#}{\#} Funding Statement This work was funded by the Global Health Innovative Technology Fund (GHIT Grant Number G2017-207), the KfW (Grant Number 2020 60 457), Commonwealth of Australia represented by the Department of Foreign Affairs and Trade (DFAT Grant Number 70957) and the Netherlands Enterprise Agency (Grant Number PDP15CH14). Graeme Meintjes was supported by the Wellcome Trust (098316, 214321/Z/18/Z, and 203135/Z/16/Z), and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No 64787). Peter MacPherson was funded by Wellcome (206575/Z/17/Z). This research was funded in part by the Wellcome Trust. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. {\#}{\#}{\#} Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committees of UCT Human Research Ethics Committee, Western Cape Government Health Impact Assessment (South Africa); College of Medicine Research Support Centre (Malawi); Biomedical Research Ethics Committee, National Health Research Authority (Zambia); Infectious Disease Institute Scientific review Committee, Mulago Hospital REC, Uganda National Council for Science and Technology (Uganda); Ifakara Health Institute Scientific Committee, Tanzania Medicines and medical Devices Authority, National Institute for Medical Research (Tanzania); National Lung Hospital Ethics Committee, Ministry of Health (Viet Nam); IRB of Faculty of Medicine, Chulalongkorn University, Bangkok Metropolitan Administration Human Research Ethics Committee, Bamrasnaradura Infectious Diseases Institute (Thailand) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Individual, de-identified participant data will be shared, including data dictionaries. Other documents that have been made available include the study protocol and statistical analysis plan. Templates of the informed consent forms may be shared upon request. The data will be available immediately following publication with no end date. The data will be shared with anyone who wishes to access the data. The data will be available for any purpose of analyses. For data, please contact the corresponding author.},
author = {Sz{\'{e}}kely, Rita and Sossen, Bianca and Mukoka, Madalo and Muyoyeta, Monde and Nakabugo, Elizabeth and Hella, Jerry and Nguyen, Hung Van and Ubolyam, Sasiwimol and Chikamatsu, Kinuyo and Mac{\'{e}}, Aur{\'{e}}lien and Vermeulen, Marcia and Centner, Chad M and Nyangu, Sarah and Sanjase, Nsala and Sasamalo, Mohamed and Dinh, Huong Thi and Ngo, Anh and Manosuthi, Weerawat and Jirajariyavej, Supunnee and Mitarai, Satoshi and Nguyen, Viet Nhung and Avihingsanon, Anchalee and Reither, Klaus and Nakiyingi, Lydia and Kerkhoff, Andrew D and Macpherson, Peter and Meintjes, Graeme A and Denkinger, Claudia M and Ruhwald, Morten},
doi = {10.1101/2022.09.07.22278961},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Sz{\'{e}}kely et al. - 2022 - Multicentre accuracy trial of FUJIFILM SILVAMP TB LAM test in people with HIV reveals lot variability.pdf:pdf},
journal = {medRxiv},
keywords = {OA,fund{\_}ack,original},
mendeley-tags = {OA,fund{\_}ack,original},
month = {sep},
pages = {2022.09.07.22278961},
publisher = {Cold Spring Harbor Laboratory Press},
title = {{Multicentre accuracy trial of FUJIFILM SILVAMP TB LAM test in people with HIV reveals lot variability}},
url = {https://www.medrxiv.org/content/10.1101/2022.09.07.22278961v1 https://www.medrxiv.org/content/10.1101/2022.09.07.22278961v1.abstract},
year = {2022}
}

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