Enhanced tuberculosis screening using computer-aided chest X-ray and SILVAMP-LAM urine diagnosis in adults with HIV admitted to hospital (CASTLE study): A cluster randomised trial

Speaker: Rachael Burke is an Infectious Disease & GIM registrar and Wellcome Clinical PhD Fellow. Her work in Malawi is centred around understanding HIV-associated TB and advanced HIV disease. She has done work on hospital epidemiology of advanced HIV disease, epidemiology of HIV-associated TB in Blantyre and a trial of implementing novel and improved TB diagnosis for people with HIV admitted to hospital. She is a member of the Malawi HIV Treatment and Care Technical Working Group, the deputy group head of MLW Population Health Group and contributed to WHO guidelines related to TB and HIV.

Topic: Adults living with HIV admitted to hospital have high mortality, with TB being the major cause of death. TB remains challenging to diagnose. New diagnostic tools might help identify more people with TB and improve clinical outcomes. This talk will be about the CASTLE trial. CASTLE was a cluster randomised trial among adult PLHIV admitted to medical wards at Zomba Central Hospital, Malawi. The trial compared enhanced TB screening using two novel diagnostic tools [urine SILVAMP-LAM (a new high sensitivity urine LAM test) and an artificial intelligence algorithm to interpret digital chest Xrays (CAD4TB)], to usual care alone. The primary outcome was TB treatment initiation during admission. Secondary outcomes were 56-day mortality, TB diagnosis within 24-hours, and undiagnosed TB at discharge. This talk will cover the CASTLE trial results and the implications for policy and practice.