Human immunodeficiency virus (HIV) clinic in Addis Ababa,
Ethiopia. The World Health Organization (WHO) recommends active tuberculosis
(TB) case-finding among people living with HIV (PLHIV) in high-burden settings.
To evaluate the effectiveness of combining a WHO-recommended
symptom screen and the Xpert(®) MTB/RIF test to enhance TB case finding.
In this cross-sectional study, PLHIV were screened for TB
using a WHO-recommended symptom-based algorithm (cough, fever, night sweats,
weight loss). Those with a positive symptom screen (⩾1 symptom)
underwent diagnostic testing with smear microscopy, culture, and Xpert.
Of 828 PLHIV (89% on antiretroviral therapy), 321 (39%) had
a positive symptom screen. In multivariate analysis, an unscheduled clinic
visit (aOR 3.78, 95%CI 2.69-5.32), CD4 count <100 cells/μl (aOR 2.62, 95%CI
1.23-5.59) and previous history of TB (aOR 1.62, 95%CI 1.12-2.31) were
predictors of a positive symptom screen. Among those with a positive symptom
screen, 6% had active pulmonary TB. Smear microscopy sensitivity for TB was
poor (30%) compared to culture and Xpert.
A positive symptom screen was common among PLHIV, creating a
substantial laboratory burden. Smear microscopy had poor sensitivity for active
TB disease. Given the high rate of positive symptom screen, substantial
additional resources are needed to implement intensified TB case finding among
PLHIV in high-burden areas.
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By:
- 1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
- 2All Africa Leprosy Rehabilitation and Training Center Hospital, Addis Ababa, Ethiopia.
- 3Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia.
- 4Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
- 5Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA.
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