Tuberculosis screening outcomes for newly diagnosed persons living with HIV, Nyanza Province, Kenya, 2009

Abstract

SUMMARY SETTING Fifteen human immunodeficiency virus (HIV) clinics in Nyanza Region, Western Kenya. OBJECTIVE To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding. DESIGN Retrospective chart abstraction of PLHIV aged ⩾7 years who were newly enrolled in HIV care in July and August 2009, and who had not received antiretroviral treatment in the preceding 2 years or been diagnosed with TB in the previous year. Factors associated with evidence of TB diagnostic evaluation among symptomatic PLHIV were assessed. RESULTS Of 1020 patients included in the analysis, 995 (98%) were screened for TB at enrolment and 613 (62%) reported TB symptoms. Ninety-six (16%) patients with symptoms had evidence of referral for TB diagnostic evaluation, including patients at large clinics, those with advanced HIV disease and those reporting multiple TB symptoms. Among the 43 (45%) with documented evaluation results, 26 (60%) were diagnosed with TB. CONCLUSION Although most PLHIV were screened for TB, very few underwent an evaluation, and the proportion diagnosed with TB was very low. Efforts to improve TB screening should focus on standardizing the intensified case finding algorithm and linkage to, and adequate infrastructure for, TB diagnostic evaluation.

Performance of and Factors Associated With Tuberculosis Screening and Diagnosis Among People Living With HIV: Analysis of 2012–2016 Routine HIV Data in Tanzania

“…In another study in Kenya among 1,060 newly enrolled PLHIV, 62% reported symptoms of TB, but only 26 cases of TB were found. This demonstrates the higher prevalence of symptoms among PLHIV prior to attending HIV services and the low sensitivity of TB screening (12). Our finding is similar to other longitudinal repeated screening of cohorts of PLHIV (21).…”

“…Ninety-five percent (95.67%) of the visitors recorded in the study cohort had TB screening. Routine TB screening is in line with the WHO recommendations (18), and such high TB screening scores among PLHIV has also been reported in other studies (12,(19)(20)(21). TB screening is known to be good to rule out TB disease in PLHIV with a negative predictive value of 97.7% (22).…”

“…A prospective study in India found that 30% screened TB positive, and 35% of these were referred for TB diagnostic tests, and 15% had confirmed TB (11). In Kenya, a study reported a high TB screening among 1,020 newly diagnosed PLHIV; 98% of PLHIV were screened, but only 16% of those screened positive underwent further TB diagnosis evaluation, and 26 (2.6%) were eventually diagnosed with TB (12). In Ethiopia, 72% of PLHIV with positive TB screening were linked to sputum microscopy for TB with the remaining PLHIV diagnosed using other methods (13).…”

Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana

“…More patients with HIV had sputum samples collected compared to those without HIV (29 samples vs 6 samples), which is likely related to an appropriately heightened clinical suspicion for TB among people living with HIV. 4 , 12 , 13 , 18 However, we saw a trend of positive smear results occurring more commonly in HIV negative individuals (83% smear positive rate) compared to HIV positive individuals (48% smear positive rate), supporting the often paucibacillary nature of HIV-associated TB. 19 Importantly, there was no difference in time to diagnosis for individuals with negative AFB smears compared to those with positive AFB smears, highlighting the delays in laboratory testing, processing of smear positive samples, and diagnosis among co-infected persons.…”

The use of laypersons to support tuberculosis screening at a Kenyan Referral Hospital

“…It is possible that the use of more sensitive diagnostic tests may have resulted in a higher TB diagnostic rate. [ 14 ] The TB Score chart had the highest diagnostic yield in children since it is comprised of a number of signs and symptoms and laboratory and radiological investigations which may have improved its yield. Sputum microscopy had the lowest diagnostic yield (20%) due to difficulties in expectoration of quality sputum in children and children most often have paucibacillary disease.…”