Authors: Were, W.¹; Moore, D.²; Ekwaru, P.¹; Mwima, G.¹; Bunnell, R.³; Kaharuza, F.¹; Rutherford, G.⁴; Mermin, J.³

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 1, January 2009 , pp. 47-53(7)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Reliable clinical algorithms that screen for active tuberculosis (TB) in human immunodeficiency virus (HIV) infected people initiating or receiving antiretroviral treatment (ART) in sub-Saharan Africa could reduce the need for diagnostic procedures.

METHODS: We estimated the utility of six TB-related signs and symptoms, alone or in combination, compared with the Uganda Ministry of Health diagnostic guidelines for participants with prevalent (baseline), early ART (≤3 months on ART) and incident TB (>3 months on ART).

RESULTS: Of 1995 participants screened for ART eligibility, 71 (3.6%) had prevalent TB. The presence of any one of the following: cough ≥3 weeks, fever ≥4 weeks, lymphadenopathy or baseline body mass index ≤18 kg/m² had a sensitivity of 99% (95%CI 96-100), a specificity of 66% (95%CI 64-68) and a negative predictive value (NPV) of 100% (95%CI 99-100) for predicting active TB. During ART follow-up, TB incidence was 2.4 (95%CI 1.6-3.4)/100 person-years. The presence of cough ≥3 weeks or general weakness was 100% sensitive (95%CI 99-100), 66% specific (95%CI 59-74) and had an NPV of 100% (95%CI 99-100).

CONCLUSION: Use of a simple TB screening algorithm can accurately identify, in a resource-poor African setting, HIV-infected individuals who require further procedures to diagnose active TB.

Keywords: HIV; ART; tuberculosis screening; Uganda

Document Type: Regular paper

Affiliations: 1: Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Uganda, Entebbe, Uganda 2: Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Uganda, Entebbe, Uganda; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; and Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 3: Global AIDS Program, CDC-Nairobi, Kenya 4: Institute for Global Health, University of California, San Francisco, California, USA

Publication date: 2009-01-01

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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.

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