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Free Content Evaluation of the World Health Organization algorithm for the diagnosis of HIV-associated sputum smear-negative tuberculosis

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Abstract:

BACKGROUND: Outcomes from the World Health Organization's (WHO's) recommendations for the diagnosis of smear-negative tuberculosis (SNTB) in high human immunodeficiency virus prevalence settings are unknown.

METHODS: We retrospectively applied the WHO algorithm for SNTB without danger signs to a prospectively enrolled cohort of ambulatory adult SNTB suspects in KwaZulu-Natal, South Africa. Participants fulfilling specified criteria for SNTB started empiric anti-tuberculosis treatment; the rest of the cohort was observed. All were followed for 8 weeks. Confirmed TB was defined as positive culture or granulomata plus acid-fast bacilli on histology.

RESULTS: In total, 221 participants retrospectively fulfilled the WHO ambulatory SNTB algorithm entry criteria. The diagnostic performance of the WHO algorithm was: positive predictive value 0.34 (95%CI 0.26–0.43), negative predictive value 0.86 (95%CI 0.76–0.92), positive likelihood ratio 1.43 (95%CI 1.34–1.48), negative likelihood ratio 0.46 (95%CI 0.38–0.56) and diagnostic odds 3.1 (95%CI 1.52–6.34). Losses to follow-up (n = 4), hospitalisations (n = 6) and deaths (n = 5) did not differ significantly in those who were and were not diagnosed with SNTB.

CONCLUSIONS: The WHO ambulatory SNTB algorithm had a reasonably high negative predictive value but low positive predictive value. Mortality over an 8-week period was low in participants who met the entry criteria for the WHO algorithm.

Keywords: HIV; WHO recommendations; performance; smear-negative tuberculosis

Document Type: Regular Paper

DOI: http://dx.doi.org/10.5588/ijtld.10.0440

Affiliations: 1: Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa; Department of Medicine, University of KwaZulu-Natal, Pretoria, South Africa 2: Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa 3: Department of Medicine, University of Cape Town, Cape Town, South Africa 4: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa 5: Department of International Health and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Department of International Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa 6: Department of International Health and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Department of International Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA 7: Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa

Publication date: July 1, 2011

More about this publication?
  • 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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