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Free Content Population-based chest X-ray screening for pulmonary tuberculosis in people living with HIV/AIDS, An Giang, Vietnam

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Abstract:

SETTING: Human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) program, An Giang Province, Vietnam.

OBJECTIVE: To evaluate the coverage and yield of a chest radiography (CXR) screening program for tuberculosis (TB) among people living with HIV/AIDS (PLHA), risk factors for a TB CXR, inter-rater reliability of CXR readings and direct costs.

DESIGN: Retrospective review of routine public health program records and CXRs.

RESULTS: An increasing proportion of PLHAs received a screening CXR each year of the program (range 21% in 2001 to 61% in 2004, P < 0.001). Of 876 screening CXRs performed, 191 (22%) were classified as suspicious for active TB (‘TB CXR’). Compared to PLHAs with a CXR not suspicious for active TB, PLHAs with a TB CXR were more likely to be aged between 24 and 64 years, male and previously treated for TB (P < 0.01 for each comparison). Agreement between the expert and local program CXR readings was 81% (kappa 0.50). Direct costs were approximately US$40 per TB suspect identified. Among TB suspects, <10% were followed up with sputum smear examination and enrolled for treatment.

CONCLUSION: In An Giang Province, a large proportion of PLHAs are screened for TB annually, and one in five persons screened is classified as a TB suspect based on CXR. Annual CXRs may be a high-yield, inexpensive method for TB screening in PLHAs, but the follow-up of TB suspects to confirm diagnosis and initiate treatment is crucial.

Keywords: HIV infection; chest radiography; diagnosis; screening; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: An Giang Province Preventive Medical Center, Long Xuyen City, Vietnam 3: Global AIDS Program, US Centers for Disease Control and Prevention, Hanoi, Vietnam 4: Vietnam National TB Program, National Hospital of Tuberculosis and Lung Diseases, Ministry of Health, Hanoi, Vietnam 5: LIFE-GAP Office, Ministry of Health, Hanoi, Vietnam 6: Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and Thailand Ministry of Public Health–US Centers for Disease Control Collaboration, Bangkok, Thailand

Publication date: 2008-04-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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