An Algorithm for Tuberculosis Screening and Diagnosis in People with HIV

Cain, Kevin P.; McCarthy, Kimberly D.; Heilig, Charles M.; Monkongdee, Patama; Tasaneeyapan, Theerawit; Kanara, Nong; Kimerling, Michael E.; Chheng, Phalkun; Thai, Sopheak; Sar, Borann; Phanuphak, Praphan; Teeratakulpisarn, Nipat; Phanuphak, Nittaya; Dung, Nguyen Huy; Quy, Hoang Thi; Thai, Le Hung; Varma, Jay K.

doi:10.1056/nejmoa0907488

Cited by 240 publications

(243 citation statements)

References 17 publications

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“…In a study of HIV-positive people in southeast Asia, cough of any duration, fever of any duration, or night sweats lasting 3 or more weeks in the previous month identifi ed tuberculosis with a sensitivity of 93% and specifi city of 36%. 57 Enquiries about the combination of these three symptoms rather than just cough seemed to be eff ective to exclude a diagnosis of tuberculosis. The role of screening by chest radiography is controversial.…”

Section: Intensifi Ed Case Fi Nding In Health Facilitiesmentioning

confidence: 99%

The HIV-associated tuberculosis epidemic—when will we act?

et al. 2010

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Journal LancetRights Reproduced on this site with permission of Elsevier Ltd. Please see [url] Tuberculosis 3The HIV-associated tuberculosis epidemic-when will we act? Anthony D Harries, Rony Zachariah, Elizabeth L Corbett, Stephen D Lawn, Ezio T Santos-Filho, Rhehab Chimzizi, Mark Harrington, Dermot Maher, Brian G Williams, Kevin M De Cock Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in aff ected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART). This approach should result in short-term and long-term declines in tuberculosis incidence through individual immune reconstitution and reduced HIV transmission. Implementation of the 3Is policy (intensifi ed tuberculosis case fi nding, infection control, and isoniazid preventive therapy) for prevention of HIV-associated tuberculosis, combined with earlier start of ART, will reduce the burden of tuberculosis in people with HIV infection and provide a safe clinical environment for delivery of ART. Some progress is being made in provision of HIV care to HIV-infected patients with tuberculosis, but too few receive co-trimoxazole prophylaxis and ART. We make practical recommendations about how to improve this situation. Early HIV diagnosis and treatment, the 3Is, and a comprehensive package of HIV care, in association with directly observed therapy, short-course (DOTS) for tuberculosis, form the basis of prevention and control of HIV-associated tuberculosis. This call to action recommends that both HIV and tuberculosis programmes exhort implementation of strategies that are known to be eff ective, and test innovative strategies that could work. The continuing HIV-associated tuberculosis epidemic needs bold but responsible action, without which the future will simply mirror the past.

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Section: Intensifi Ed Case Fi Nding In Health Facilitiesmentioning

confidence: 99%

The HIV-associated tuberculosis epidemic—when will we act?

et al. 2010

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“…17 Because national guidelines rely on symptom screening for ruling out TB, and we intended to address provider uncertainty with regard to ruling out TB, we prospectively evaluated a standardized guided screening process for TB among PLHIV eligible for IPT. The guided process included a paper-based tool that prompted review of patient history (household members with TB in the last year, previous history of TB treatment or IPT, and contraindications for IPT), a simplified symptom screen using three questions with high positive predictive value (cough or fever of any duration in the previous 4 weeks, night sweats in 3 of the past 4 weeks), 18 and sputum analyses by acid-fast bacilli (AFB) smear and Xpert, regardless of symptoms ( Figure 1). We selected the three-question symptom screen based on evidence that these symptoms can accurately rule out TB in the vast majority of PLHIV.…”

Section: Public Health Actionmentioning

confidence: 99%

“…We selected the three-question symptom screen based on evidence that these symptoms can accurately rule out TB in the vast majority of PLHIV. 18,19 Chest X-ray (CXR) was conducted selectively when clinical suspicion of TB persisted in the absence of positive smear microscopy or Xpert results. When a patient was unable to produce a sputum sample, sputum induction with nebulized hypertonic saline was recommended.…”

Section: Public Health Actionmentioning

confidence: 99%

Increasing isoniazid preventive therapy uptake in an HIV program in rural Papua New Guinea

Carmone¹,

Rodriguez

Frank³

et al. 2017

public health action

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Setting: Tuberculosis (TB) is the leading cause of death among people living with the human immunodeficiency virus (PLHIV) in Papua New Guinea. Despite a policy for isoniazid preventive therapy (IPT) among PLHIV, implementation has been slow. Objective: We prospectively evaluated a standardized guided screening process, including TB diagnostic support, to increase IPT initiation in adult PLHIV on antiretroviral treatment. Design: The guided process included a paper-based IPT screening tool that prompted review of patient history and TB symptoms and sputum analysis by smear microscopy and Xpert ® MTB/RIF. Chest X-ray was performed at the provider's discretion. We quantified the yield of this guided process on IPT initiation and detection of TB and rifampicin resistance, and examined the contributions of each diagnostic modality. Results: Among 532 patients, TB was ruled out and IPT initiated in 450 (84%). TB was diagnosed and treatment was started in 82 (15%) patients. Xpert detected rifampicin resistance in one of 21 patients (5%, 95%CI 0.24-21.3) with a positive Xpert result. All TB cases were diagnosed by chest X-ray and/or Xpert. No cases were diagnosed by sputum smear alone. Conclusion: A standardized guided process, including TB diagnostic support, successfully enabled IPT initiation and identified a large burden of undetected TB.

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“…If the CD4 cells counts found less than 75 per cubic millimeter, pulmonary tuberculosis may be absent, and outstretched tuberculosis, incurable illness with extensive organ participation and mycobacteremia, with a high rate of mortality 21 . Asymptomatic tuberculosis with a negative result of a chest radiography and sputum smear and culture results found to be positive is a common symptom of HIV-associated tuberculosis and 10% of cases in which tuberculosis is spatial 22,23 . Whereas up to 25% of HIV patients have unrecognized active tuberculosis 3 .…”

Section: Clinical Featuresmentioning

confidence: 99%