Tuberculosis Case Finding in HIV-Infected Pregnant Women in Kenya Reveals Poor Performance of Symptom Screening & Rapid Diagnostic Tests

Tuberculosis (TB) during pregnancy in HIV-infected women is associated with poor maternal and infant outcomes. There are limited data on TB prevalence, optimal TB screening, and performance of rapid diagnostics in pregnant HIV-infected women.

Between July 2013 and July 2014, we enrolled 306 women. Among 288 women with a valid sputum culture result, 54% were on antiretroviral treatment, median CD4 cell count was 437 cell/mm (IQR 342-565), and prevalence of culture-confirmed pulmonary TB was 2.4% (CI 1.0-4.9%). Cough >2 weeks (p=0.04) and positive TST (>5mm, p=0.03) were associated with pulmonary TB. Women with TB were 23-fold (95% CI 4.4-116.6) more likely to report a household member with TB symptoms (p=0.002). WHO symptom screen (43%), AFB smear (0%), Xpert (43%) and LAM (0%) had low sensitivity but high specificity (81%, 99%, 99% and 95%, respectively) for pulmonary TB.

HIV-infected pregnant women had appreciable prevalence of pulmonary TB despite modest immunosuppression. Current TB screening and diagnostic tools perform poorly in pregnant HIV-infected women. Adapted TB screening tools that include household member TB symptoms may be useful in this population.

Via:  http://ht.ly/S1NnU 

By: LaCourse SM1, Cranmer LM, Matemo D, Kinuthia J, Richardson BA, John-Stewart G, Horne DJ.

• 1Departments of 1Medicine, 2Epidemiology, 3Pediatrics, 4Global Health, 5Biostatistics, 6Firland Northwest Tuberculosis Center, University of Washington, Seattle, WA, USA, 7Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA, Departments of 8Research and Programs, 9Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya.

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