Screening for hepatocellular carcinoma among adults with HIV/HBV co-infection in Zambia: a pilot study.

BACKGROUND AND AIMS: Chronic hepatitis B virus (HBV) infection is the main cause of hepatocellular carcinoma (HCC) in sub-Saharan Africa (SSA). An HCC screening initiative was piloted in an established cohort of individuals co-infected with human immunodeficiency virus (HIV) and HBV on antiretroviral therapy (ART) at two outpatient clinics in Lusaka, Zambia. METHODS: All patients underwent abdominal ultrasound (AUS) and transient elastography. RESULTS: Among 279 patients co-infected with HIV/HBV, 165 (59.1%) were men, median age was 34 years [interquartile range (IQR) 28-39 years] and median CD4 count was 246 cells/µL (IQR 112-355 cells/µL) at ART initiation. While 102 (55.7%) individuals had elevated transaminases, 114 (59.7%) had HBV levels >2000 IU/mL and 59 (24.6%) had significant fibrosis. At their first AUS measurement, 75 (26.9%) participants had hepatomegaly and 69 (24.7%) had periportal fibrosis. Five patients had a liver lesion >1 cm, an indication for confirmatory imaging. CONCLUSIONS: In one of the first HCC screening initiatives in SSA, 2% of patients co-infected with HIV/HBV had significant liver lesions, and one-quarter had findings suggestive of schistosomiasis-induced liver damage.

Automatic versus human reading of chest X-rays in the Zambia National Tuberculosis Prevalence Survey.

SETTING: Tuberculosis (TB) prevalence survey in Zambia between 2013 and 2014. OBJECTIVE: To compare the performance of automatic software (CAD4TB 5) in chest X-ray (CXR) reading with that of field (general practitioners) and central (radiologists) readers. DESIGN: A retrospective study comparing the performance of human and automatic reading was conducted. Two scenarios for central reading were evaluated: abnormalities not consistent with TB were considered to be 'normal' or 'abnormal'. Sputum culture was defined as the reference standard. Measures derived from receiver operating characteristic analysis were used to assess readers' performances. RESULTS: Of 46 099 participants, 23 838 cases included all survey information; of these, 106 cases were culture-confirmed TB-positive. The performance of CAD4TB 5 was similar to that of field and central readers. Although there were significant differences in specificity when compared with field readings (P = 0.002) and central readings considering the first scenario (P < 0.001), these differences were not substantial (93.2% vs. 92.6% and 98.4% vs. 99.6%, respectively).CONCLUSIONp: The performance of automatic CXR readings is comparable with that of human experts in a TB prevalence survey setting using culture as reference.