High <scp>HIV</scp> and active tuberculosis prevalence and increased mortality risk in adults with symptoms of <scp>TB</scp>: a systematic review and meta‐analyses

Nliwasa, Marriott; MacPherson, Peter; Gupta-Wright, Ankur; Mwapasa, Mphatso; Horton, Katherine C.; Odland, Jon Øyvind; Flach, Clare; Corbett, Elizabeth L.

doi:10.1002/jia2.25162

Cited by 28 publications

(21 citation statements)

References 69 publications

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“…TB misdiagnosis has been reported to occur in rural health care centers and overcrowded reference health centers run by health care workers with limited training 15 , 41 , 42 . A recent cohort study conducted in Malawi, which assessed presumptive TB adults with chronic cough after 12 months of the initial visit found that TB was diagnosed in 10% of these patients and the mortality risk was of 4.1% 43 . Another prospective study in Zambia found that in those inpatients without presumptive TB (i.e.…”

Section: Discussionmentioning

confidence: 99%

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

García

Mambuque

Nguenha

et al. 2020

Sci Rep

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Tuberculosis (TB) misdiagnosis remains a public health concern, especially among people living with HIV (PLHIV), given the high mortality associated with missed TB diagnoses. The main objective of this study was to describe the all-cause mortality, TB incidence rates and their associated risk factors in a cohort of PLHIV with presumptive TB in whom TB was initially ruled out. We retrospectively followed a cohort of PLHIV with presumptive TB over a 2 year-period in a rural district in Southern Mozambique. During the study period 382 PLHIV were followed-up. Mortality rate was 6.8/100 person-years (PYs) (95% CI 5.2–9.2) and TB incidence rate was 5.4/100 PYs (95% CI 3.9–7.5). Thirty-six percent of deaths and 43% of TB incident cases occurred in the first 12 months of the follow up. Mortality and TB incidence rates in the 2-year period after TB was initially ruled out was very high. The TB diagnostic work-up and linkage to HIV care should be strengthened to decrease TB burden and all-cause mortality among PLHIV with presumptive TB.

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Section: Discussionmentioning

confidence: 99%

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

García

Mambuque

Nguenha

et al. 2020

Sci Rep

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“…Triage tests aim to rule-out TB, allowing health workers to prioritise patients with a higher prior probability of TB for more expensive, slower con rmatory tests such as Xpert or culture. [40] Individual and public health consequences of ine ciencies in establishing a diagnosis and providing prompt and effective treatment of TB include premature death, as patients with undiagnosed TB have a high mortality rate especially if also living with HIV, [5] and more severe post-tuberculous lung disease and other permanent sequelae of TB. [43] Increasingly severe illness tends to prompt multiple healthcare visits, with patients incurring pre-diagnosis "catastrophic costs" and repeated courses of non-speci c treatments including broad-spectrum antibiotics until their TB is nally diagnosed.…”

Section: Discussionmentioning

confidence: 99%

Missed opportunities for diagnosis and treatment in patients with tuberculosis symptoms: a systematic review

Divala

Lewis

Bulterys³

et al. 2020

Preprint

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Background Identification of symptomatic patients followed by prompt on-site investigation form the foundation of facility-based tuberculosis (TB) screening and diagnosis. However, underdiagnosis is common, contributing to ongoing transmission and adverse health outcomes. We conducted this systematic review with the hypothesis that underdiagnosis is largely secondary to to failure of the symptom-screen-based approach to efficiently identify patients at risk of TB. Methods We searched (to 22 January 2019) MEDLINE, Embase, and Cinahl for studies investigating the pathway of care for patients (and standardised patients) presenting to health facilities or pharmacies with TB symptoms. We used QUADAS-2 to assess risk of bias. We reported the proportions of symptomatic patients at each stage of the diagnostic and care pathway from symptom screening to treatment initiation. We adhered to the PRISMA statement throughout this work. Results After screening 3,184 titles and abstracts, we identified 14 eligible studies. None provided data addressing the full cascade of care from clinical presentation to treatment initiation in the same patient population. Symptom-screening, the critical entry point for diagnosis of TB, was not done for 40%, 50%, and 96% of symptomatic participants in the three studies that reported this outcome. The proportion of symptomatic attendees offered a diagnostic investigation (data available for 13 studies), was very low with a study level median of 38% (IQR: 22% to 45%, range 5% to 84%).Conclusions Inefficiencies of the TB symptom screen-based patient pathway are a major contributor to underdiagnosis of TB in health facilities, and reflect inconsistent implementation of longstanding guidelines to ask all patients attending health facilities about respiratory symptoms and to offer diagnostic tests to all patients promptly once TB symptoms are identified. Screening tools and interventions with better diagnostic performance than symptoms, are urgently needed to improve the efficiency of TB care pathways in health facilities.

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“…[8] In fact, in settings with generalised HIV epidemics those presenting with TB symptoms have higher prevalence of HIV than people with confirmed TB. [9] Despite the high HIV prevalence in patients with TB symptoms, they are not listed as a priority screening group in the Malawian National Strategic Plan for HIV and AIDS. [10] This study investigated PITC uptake for those with and without TB symptoms at a busy primary health care centre in Malawi.…”

Section: Introductionmentioning

confidence: 99%

Provider-initiated HIV testing and TB screening in the era of universal coverage: Are the right people being reached? A cohort study in Blantyre, Malawi

et al. 2020

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Introduction Patients with tuberculosis (TB) symptoms have high prevalence of HIV, and should be prioritised for HIV testing. Methods In a prospective cohort study in Bangwe primary care clinic, Blantyre, Malawi, all adults (18 years or older) presenting with an acute illness were screened for TB symptoms (cough, fever, night sweats, weight loss). Demographic characteristics were linked to exit interview by fingerprint bioidentification. Multivariable logistic regression models were constructed to estimate the proportion completing same-visit HIV testing, comparing between those with and without TB symptoms. Results There were 5427 adult attendees between 21/5/2018 and 6/9/2018. Exit interviews were performed for 2402 (44%). 276 patients were excluded from the analysis, being already on antiretroviral therapy (ART). Presentation with any TB symptom was common for men (54.6%) and women (57.4%). Overall 27.6% (585/ 2121) attenders reported being offered testing and 21.5% (455/2121) completed provider-initiated HIV testing and counselling (PITC) and received results. The proportions offered testing were similar among participants with and without TB symptoms (any TB symptom: 29.0% vs. 25.7%). This was consistent for each individual symptom; cough, weight loss, fever and night sweats. Multivariable

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High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta‐analyses

Cited by 28 publications

References 69 publications

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

Missed opportunities for diagnosis and treatment in patients with tuberculosis symptoms: a systematic review

Provider-initiated HIV testing and TB screening in the era of universal coverage: Are the right people being reached? A cohort study in Blantyre, Malawi

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