Population-based chest X-ray screening for pulmonary tuberculosis in people living with HIV/AIDS, An Giang, Vietnam
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.
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: April 1, 2008
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