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. 2013 Oct 17;8(10):e77697.
doi: 10.1371/journal.pone.0077697. eCollection 2013.

Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening

Affiliations

Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening

Lukas Fenner et al. PLoS One. .

Abstract

Objectives: In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries.

Methods and findings: We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%).

Conclusions: Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.

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Conflict of interest statement

Competing Interests: Omar Sued who is co-author on this manuscript is an editorial member of PLOS ONE. Timothy R. Sterling reports grant support to Vanderbilt University from Pfizer, Bristol Myers Squibb and Virco. Timothy R. Sterling has acted as a consultant to Sanofi-Aventis and is a member of a Data Safety Monitoring Board for Otsuka. All other authors declare that they have no competing interests. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Geographical distribution of the 47 ART programs the International epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration, which treat adults in lower income countries and participated in the survey project.
The regions correspond to the IeDEA regions. Countries with at least one site completing Section A of the questionnaire are shown. Numbers in parentheses indicate the number of adult ART programs included in the analysis.

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