5.2.4 WHO-recommended rapid molecular diagnostic tests

WHO-recommended rapid molecular diagnostic tests

mWRDs are now also recommended for screening people living with HIV. (See 3.1.4 for a full description of their use in screening). A positive mWRD screen result in a person with HIV must be followed by further diagnostic evaluation to confirm or rule out TB.

Among medical inpatients in settings where the prevalence of TB is ≥ 10%, mWRDs are strongly recommended for screening for TB disease because of the severity of illness in this population. As rapid diagnosis and care are required, a positive mWRD result in this population can be considered an indication for treatment and need not be followed by a separate diagnostic evaluation, while ensuring proper monitoring of treatment response and evaluation for alternative diagnoses, particularly if the patient had TB in the previous 5 years.

Table 5.4 shows the accuracy of mWRD screening in different sub-populations of adults and adolescents living with HIV. The overall sensitivity of mWRD in all people living with HIV is estimated to be 69% and the specificity 98%, while W4SS followed by a mWRD is estimated to have a sensitivity of 62% and a specificity of 99% (see Web Annex B of the guidelines). The accuracy of mWRD in most subpopulations is not significantly different from that of W4SS followed by mWRD.

Diagnostic accuracy of mWRD for screening for TB

For more detail, see Web Annex B of the screening guidelines.

Indicator of advanced HIV disease

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