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Comparative Study
. 2015 Oct;19(10):1197-203.
doi: 10.5588/ijtld.15.0230.

Intensified tuberculosis case finding among HIV-infected persons using a WHO symptom screen and Xpert(®) MTB/RIF

M W Adelman  1 , M Tsegaye  2 , R R Kempker  1 , T Alebachew  3 , K Haile  2 , A Tesfaye  3 , A Aseffa  4 , H M Blumberg  5
Affiliations
Comparative Study

Intensified tuberculosis case finding among HIV-infected persons using a WHO symptom screen and Xpert(®) MTB/RIF

M W Adelman et al. Int J Tuberc Lung Dis. 2015 Oct.

Abstract

Setting: Human immunodeficiency virus (HIV) clinic in Addis Ababa, Ethiopia. The World Health Organization (WHO) recommends active tuberculosis (TB) case-finding among people living with HIV (PLHIV) in high-burden settings.

Objective: To evaluate the effectiveness of combining a WHO-recommended symptom screen and the Xpert(®) MTB/RIF test to enhance TB case finding.

Design: In this cross-sectional study, PLHIV were screened for TB using a WHO-recommended symptom-based algorithm (cough, fever, night sweats, weight loss). Those with a positive symptom screen (⩾1 symptom) underwent diagnostic testing with smear microscopy, culture, and Xpert.

Results: Of 828 PLHIV (89% on antiretroviral therapy), 321 (39%) had a positive symptom screen. In multivariate analysis, an unscheduled clinic visit (aOR 3.78, 95%CI 2.69-5.32), CD4 count <100 cells/μl (aOR 2.62, 95%CI 1.23-5.59) and previous history of TB (aOR 1.62, 95%CI 1.12-2.31) were predictors of a positive symptom screen. Among those with a positive symptom screen, 6% had active pulmonary TB. Smear microscopy sensitivity for TB was poor (30%) compared to culture and Xpert.

Conclusions: A positive symptom screen was common among PLHIV, creating a substantial laboratory burden. Smear microscopy had poor sensitivity for active TB disease. Given the high rate of positive symptom screen, substantial additional resources are needed to implement intensified TB case finding among PLHIV in high-burden areas.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure
Figure
Flow diagram of HIV-infected patients included in the primary study. Those patients included in the study underwent a WHO-recommended symptom screen, which included asking the patient about the presence of four symptoms (fever, cough, weight loss and night sweats), followed by diagnostic testing for TB on sputum if one or more symptoms were present. Active TB disease was defined as a positive Xpert result and/or a positive AFB culture for M. tuberculosis. TB = tuberculosis; + = positive; − = negative; HIV = human immunodeficiency virus; WHO = World Health Organization; AFB = acid-fast bacilli.
See this image and copyright information in PMC

References

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