Authors: Agizew, T.B.¹; Arwady, M.A.¹; Yoon, J.C.¹; Nyirenda, S.¹; Mosimaneotsile, B.¹; Tedla, Z.¹; Motsamai, O.²; Kilmarx, P.H.³; Wells, C.D.⁴; Samandari, T.⁵

Source: The International Journal of Tuberculosis and Lung Disease, Volume 14, Number 1, January 2010 , pp. 45-51(7)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

BACKGROUND: Isoniazid preventive therapy (IPT) prevents tuberculosis (TB) in people living with HIV (human immunodeficiency virus, PLWH). Symptom screening without chest radiographs (CXRs) was established as the strategy for excluding TB disease among PLWH seeking IPT in Botswana's 2001 pilot project. This strategy was evaluated in 2004-2006 among candidates screened for an IPT clinical trial.

METHODS: PLWH referred from clinics and HIV testing centers were screened for TB symptoms. All asymptomatic candidates received CXRs; those with abnormal CXRs were investigated further.

RESULTS: Among 2732 asymptomatic candidates screened, 302 (11%) had abnormal CXRs potentially compatible with TB; TB disease was diagnosed in 43 of these 302 (14%), or 43 (1.6%) of the 2732 asymptomatic candidates. While not associated with CD4 lymphocyte counts < 200 cells/mm³, TB was associated with a positive tuberculin skin test (relative risk 2.1, 95%CI 1.1-4.0). IPT was initiated in 113 (62%) of 182 asymptomatic PLWH with abnormal CXRs; 8/113 (7%) subsequently developed TB, and 7/8 (88%) successfully completed anti-tuberculosis treatment.

CONCLUSIONS: The prevalences of abnormal CXRs and TB were respectively 2.6- and 8.9-fold higher among asymptomatic PLWH screened for the trial than in the pilot. A cost-effectiveness analysis is needed to determine whether the benefits of symptom screening alone are offset by the risk of inducing INH resistance by excluding CXRs during screening.

Keywords: tuberculosis; HIV/AIDS; preventive therapy; isoniazid; screening

Document Type: Regular paper

Affiliations: 1: BOTUSA, Gaborone, Botswana 2: National TB Program, Ministry of Health, Gaborone, Botswana 3: BOTUSA, Gaborone, Botswana; and Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 5: BOTUSA, Gaborone, Botswana; and Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: 2010-01-01

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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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