Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Modi, Surbhi ; Cavanaugh, Joseph S. ; Shiraishi, Ray W. ; Alexander, Heather L. ; McCarthy, Kimberly D. ; Burmen, Barbara ; Muttai, Hellen ; Heilig, Chad M. ; Nakashima, Allyn K. ; Cain, Kevin P.
• Description:
  Objective
  
  To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya.
  
  Design
  
  Prospective cohort study
  
  Methods
  
  PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and “Improving Diagnosis of TB in HIV-infected persons” (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey.
  
  Results
  
  Overall, 738 (85.6%) of 862 PLHIV enrolled were included in the analysis. Estimated TB prevalence was 11.2% (95% CI, 9.9–12.7). Sensitivity of the three screening algorithms was similar [WHO, 74.1% (95% CI, 64.1–82.2); MOH, 77.5% (95% CI, 68.6–84.5); and ID-TB/HIV, 72.5% (95% CI, 60.9–81.7)]. Sensitivity of the WHO algorithm was significantly lower among HIV-infected pregnant women [28.2% (95% CI, 14.9–46.7)] compared to non-pregnant women [78.3% (95% CI, 67.3–86.4)] and men [77.2% (95% CI, 68.3–84.2)]. Chest radiography increased WHO algorithm sensitivity and negative predictive value to 90.9% (95% CI, 86.4–93.9) and 96.1% (95% CI, 94.4–97.3), respectively, among asymptomatic men and non-pregnant women.
  
  Conclusions
  
  Clinical screening missed approximately 25% of laboratory-confirmed TB cases among all PLHIV and more than 70% among HIV-infected pregnant women. National HIV programs should evaluate the feasibility of laboratory-based screening for TB, such as a single Xpert MTB/RIF test for all PLHIV, especially pregnant women, at enrollment in HIV services.
  
  
• Subjects:
  Adolescent Adult Female HIV Infections Humans Male Mass Chest X-Ray Middle Aged Pregnancy Prospective Studies Tuberculosis Young Adult

  More +
• Source:
  PLoS One. 11(12).
• Pubmed ID:
  27936146
• Pubmed Central ID:
  PMC5147932
• Document Type:
  Journal Article
• Name as Subject:
  United States. President's Emergency Plan For AIDS Relief (PEPFAR)
• Place as Subject:
  Kenya
• Volume:
  11
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:e9ba8a6ca649f5c6697aa5f5c3ea470fbc17222ae999123906dff4537f2304a785aca3779f588f8b56144d863f2c2bed3e818bf9d267ab4de94ff7b989b40622
• Download URL:
  https://stacks.cdc.gov/view/cdc/43673/cdc_43673_DS1.pdf
• File Type:
  [PDF - 1000.38 KB ]