Free Content Evaluation of the Arkansas method of urine testing for isoniazid in South Africa

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Abstract:

SETTING: A South African hospital serving gold mine employees.

OBJECTIVE: To determine the sensitivity and specificity of the Arkansas method for detecting isoniazid (INH) metabolites among South African adults and to examine the effect of smoking status on positive results.

DESIGN: Urine specimens were collected from in-patients taking INH as part of tuberculosis treatment at 6, 12 and 24 h after a directly observed 300 mg oral dose. As a control group, a single urine specimen was collected from surgical in-patients not taking INH. Specimens were tested for INH using a commercially available dipstick.

RESULTS: A total of 153 patients on INH and 60 controls were recruited. The sensitivity of the test was 93.3% (95%CI 88.1–96.8) at 6 h post INH, 93.4% (95%CI 88.2–96.8) at 12 h and 77% (95%CI 69.1–83.7) at 24 h. The specificity of the test was 98.3% (95%CI 91.1–>99.9). There was no association between smoking status and colour change of positive results.

CONCLUSIONS: This test is a useful method of monitoring adherence to TB treatment or preventive therapy among South Africans. However, it is less than 100% sensitive, especially with increasing time post dose, which should be taken into consideration when interpreting results for individual patients.

Keywords: Africa; adherence; isoniazid; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Aurum Institute for Health Research, Johannesburg, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa 2: Aurum Institute for Health Research, Johannesburg, South Africa 3: Aurum Institute for Health Research, Johannesburg, South Africa; and London School of Hygiene & Tropical Medicine, London, UK 4: London School of Hygiene & Tropical Medicine, London, UK 5: Aurum Institute for Health Research, Johannesburg, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; and London School of Hygiene & Tropical Medicine, London, UK

Publication date: November 1, 2007

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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