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. 2017 Mar 3;12(3):e0172881.
doi: 10.1371/journal.pone.0172881. eCollection 2017.

Symptom screening rules to identify active pulmonary tuberculosis: Findings from the Zambian South African Tuberculosis and HIV/AIDS Reduction (ZAMSTAR) trial prevalence surveys

M M Claassens  1 , C van Schalkwyk  2 , S Floyd  3 , H Ayles  3   4 , N Beyers  1
Affiliations

Symptom screening rules to identify active pulmonary tuberculosis: Findings from the Zambian South African Tuberculosis and HIV/AIDS Reduction (ZAMSTAR) trial prevalence surveys

M M Claassens et al. PLoS One. .

Abstract

Background: High tuberculosis (TB) burden countries should consider systematic screening among adults in the general population. We identified symptom screening rules to be used in addition to cough ≥2 weeks, in a context where X-ray screening is not feasible, aiming to increase the sensitivity of screening while achieving a specificity of ≥85%.

Methods: We used 2010 Zambia South Africa Tuberculosis and HIV/AIDS Reduction (ZAMSTAR) survey data: a South African (SA) training dataset, a SA testing dataset for internal validation and a Zambian dataset for external validation. Regression analyses investigated relationships between symptoms or combinations of symptoms and active disease. Sensitivity and specificity were calculated for candidate rules.

Results: Among all participants, the sensitivity of using only cough ≥2 weeks as a screening rule was less than 25% in both SA and Zambia. The addition of any three of six TB symptoms (cough <2 weeks, night sweats, weight loss, fever, chest pain, shortness of breath), or 2 or more of cough <2 weeks, night sweats, and weight loss, increased the sensitivity to ~38%, while reducing specificity from ~95% to ~85% in SA and ~97% to ~92% in Zambia. Among HIV-negative adults, findings were similar in SA, whereas in Zambia the increase in sensitivity was relatively small (15% to 22%).

Conclusion: High TB burden countries should investigate cost-effective strategies for systematic screening: one such strategy could be to use our rule in addition to cough ≥2 weeks.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Sensitivity and specificity for selected screening rules in all individuals regardless of HIV status and in HIV negative individuals, in South Africa and Zambia.
Symptoms: cough <2 weeks, night sweats, weight loss, fever, chest pain, shortness of breath; CSW: cough <2 weeks, night sweats, weight loss; CSWF: cough <2 weeks, night sweats, weight loss, fever.
See this image and copyright information in PMC

References

    1. TB CARE I. International Standards for Tuberculosis Care, Edition 3. The Hague; 2014.
    1. Kranzer K, Afnan-Holmes H, Tomlin K, Golub JE, Shapiro AE, Schaap A, et al. The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review. Int J Tuberc Lung Dis. 2013;17(4):432–46. 10.5588/ijtld.12.0743 - DOI - PubMed
    1. Getahun H, Kittikraisak W, Heilig CM, Corbett EL, Ayles H, Cain KP, et al. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med. 2011. January;8(1):e1000391 10.1371/journal.pmed.1000391 - DOI - PMC - PubMed
    1. World Health Organization. Global Tuberculosis Report 2013. Geneva; 2013.
    1. van’t Hoog AH, Meme HK, Laserson KF, Agaya JA, Muchiri BG, Githui WA, et al. Screening strategies for tuberculosis prevalence surveys: the value of chest radiography and symptoms. PLoS One. 2012. January;7(7):e38691 10.1371/journal.pone.0038691 - DOI - PMC - PubMed

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