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Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya.
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.
Afiliación
  • Modi S; Division of Global HIV & TB, United States Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
  • Cavanaugh JS; Division of Tuberculosis Elimination, CDC, Atlanta, Georgia, United States of America.
  • Shiraishi RW; Division of Global HIV & TB, United States Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
  • Alexander HL; Division of Global HIV & TB, United States Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
  • McCarthy KD; Division of Tuberculosis Elimination, CDC, Atlanta, Georgia, United States of America.
  • Burmen B; Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya.
  • Muttai H; KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya.
  • Heilig CM; CDC, Kisumu, Kenya.
  • Nakashima AK; Division of Tuberculosis Elimination, CDC, Atlanta, Georgia, United States of America.
  • Cain KP; Division of Global HIV & TB, United States Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
PLoS One ; 11(12): e0167685, 2016.
Article en En | MEDLINE | ID: mdl-27936146
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.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Tuberculosis / Infecciones por VIH Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Adolescent / Adult / Female / Humans / Male / Middle aged / Pregnancy País/Región como asunto: Africa Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Tuberculosis / Infecciones por VIH Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Adolescent / Adult / Female / Humans / Male / Middle aged / Pregnancy País/Región como asunto: Africa Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos