Intensified tuberculosis case finding among HIV-infected persons using a WHO symptom screen and Xpert® MTB/RIF

被引：21

作者：

Adelman, M. W. ^{[1
]}

Tsegaye, M. ^{[2
]}

Kempker, R. R. ^{[1
]}

Alebachew, T. ^{[3
]}

Haile, K. ^{[2
]}

Tesfaye, A. ^{[3
]}

Aseffa, A. ^{[4
]}

Blumberg, H. M. ^{[1
,5
,6
]}

机构：

[1] Emory Univ, Div Infect Dis, Dept Med, Sch Med, Atlanta, GA 30322 USA

[2] All Africa Leprosy Rehabil & Training Ctr Hosp, Addis Ababa, Ethiopia

[3] Addis Ababa City Adm, Hlth Bur, Addis Ababa, Ethiopia

[4] Armauer Hansen Res Inst, Addis Ababa, Ethiopia

[5] Emory Univ, Hubert Dept Global Hlth, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA

[6] Emory Univ, Dept Epidemiol, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA

来源：

INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE | 2015年 / 19卷 / 10期

基金：

美国国家卫生研究院;

关键词：

operational research; developing countries; Ethiopia; implementation science; PUBLIC-HEALTH; ADDIS-ABABA; PEOPLE; IMPLEMENTATION; SETTINGS;

D O I：

10.5588/ijtld.15.0230

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

SETTING: 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. OBJECTIVE: To evaluate the effectiveness of combining a WHO-recommended symptom screen and the Xpert (R) MTB/RIF test to enhance TB case finding. DESIGN: 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 (symptom) underwent diagnostic testing with smear microscopy, culture, and Xpert. RESULTS: 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/mu 1 (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. CONCLUSIONS: 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.

引用

页码：1197 / 1203

页数：7

共 27 条

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