Tuberculosis screening outcomes for newly diagnosed persons living with HIV, Nyanza Province, Kenya, 2009

Abstract

Setting: Fifteen human immunodeficiency virus (HIV) clinics in Nyanza Region, Western Kenya.

Objective: To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding.

Design: Retrospective chart abstraction of PLHIV aged ⩾7 years who were newly enrolled in HIV care in July and August 2009, and who had not received antiretroviral treatment in the preceding 2 years or been diagnosed with TB in the previous year. Factors associated with evidence of TB diagnostic evaluation among symptomatic PLHIV were assessed.

Results: Of 1020 patients included in the analysis, 995 (98%) were screened for TB at enrolment and 613 (62%) reported TB symptoms. Ninety-six (16%) patients with symptoms had evidence of referral for TB diagnostic evaluation, including patients at large clinics, those with advanced HIV disease and those reporting multiple TB symptoms. Among the 43 (45%) with documented evaluation results, 26 (60%) were diagnosed with TB.

Conclusion: Although most PLHIV were screened for TB, very few underwent an evaluation, and the proportion diagnosed with TB was very low. Efforts to improve TB screening should focus on standardizing the intensified case finding algorithm and linkage to, and adequate infrastructure for, TB diagnostic evaluation.

Figure

TB screening and evaluation at enrollment into HIV care. * Different sets of symptoms were used for screening at enrollment; some patients were screened based only on their presenting complaints. ^† 19 of these patients did not return to the clinic after referral for TB diagnostic evaluation. ^‡ 2 patients had negative results. ^§ These 14 patients had no TB diagnostic evaluation but were started on anti-tuberculosis treatment. ^¶ Clinicians noted that these patients were started on anti-tuberculosis treatment. One patient had a negative sputum microscopy documented, 2 patients had no documented sputum microscopy or CXR results. HIV = human immunodeficiency virus; TB = tuberculosis; CXR = chest X-ray.