Yield of Screening for TB and HIV among Children Failing to Thrive in Botswana

Arscott-Mills, Tonya; Ho-Foster, Ari; Lowenstein, Margaret; Jibril, Haruna; Masunge, Japhter; Mweemba, P; Nashara, Paul; Makombe, Robert; Chirenda, Joconiah; Friedman, Harvey M.; Steenhoff, Andrew P.; Harari, Nurit

doi:10.1093/tropej/fmt072

Cited by 12 publications

(8 citation statements)

References 9 publications

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“…The reason for these findings is not apparent but are similar to those reported in a study in western Kenya [27]. In children, the additional symptoms required for screening, such as failure to thrive, and lethargy were sub-optimally documented, showing missed opportunities for actively looking for TB among them, which has been evidenced to detect TB cases [29]. The IPT completion rates in Kenya were above 95%, which is higher compared to other African countries, where it ranges from 70-94% [30][31][32].…”

Section: Plos Onesupporting

confidence: 74%

Outcomes of isoniazid preventive therapy among people living with HIV in Kenya: A retrospective study of routine health care data

et al. 2020

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Introduction Isoniazid preventive therapy (IPT) taken by People Living with HIV (PLHIV) protects against active tuberculosis (TB). Despite its recommendation, data is scarce on the uptake of IPT among PLHIV and factors associated with treatment outcomes. We aimed at determining the proportion of PLHIV initiated on IPT, assessed TB screening practices during and after IPT and IPT treatment outcomes. Methods A retrospective cohort study of a representative sample of PLHIV initiated on IPT between July 2015 and June 2018 in Kenya. For PLHIV initiated on IPT during the study period, we abstracted patient IPT uptake data from the National data warehouse. In contrast, we obtained information on socio-demographic, TB screening practices, IPT initiation, follow up, and outcomes from health facilities' patient record cards, IPT cards, and IPT registers. Further, we assessed baseline characteristics as potential correlates of developing active TB during and after treatment and IPT completion using multivariable logistic regression. Results From the data warehouse, 138,442 PLHIV were enrolled into ART during the study period and initiated 95,431 (68.9%) into IPT. We abstracted 4708 patients’ files initiated on IPT, out of which 3891(82.6%) had IPT treatment outcomes documented, 4356(92.5%) had ever screened for TB at every clinic visit, and 4,243(90.1%) had documentation of TB screening on the IPT tool before IPT initiation. 3712(95.4%) of patients with documented IPT treatment outcomes completed their treatment. 42(0.89%) of the abstracted patients developed active TB,16(38.1%) during, and 26(61.9%) after completing IPT. Follow up for active TB at 6-month post-IPT completion was done for 2729(73.5%) of patients with IPT treatment outcomes. Sex, Viral load suppression, and clinic type were associated with TB development (p<0.05). Levels 4, 5, FBO, and private facilities and IPT prescription practices were associated with IPT completion (p<0.05). Conclusion IPT initiation stands at two-thirds of the PLHIV, with a high completion rate. TB screening practices were better during IPT than after completion. Development of active TB during and after IPT emphasizes the need for a keen follow up.

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Section: Plos Onesupporting

confidence: 74%

Outcomes of isoniazid preventive therapy among people living with HIV in Kenya: A retrospective study of routine health care data

et al. 2020

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“…7 Paediatric inpatient programmes were the most common context (17), 6,7,10,[13][14][15][16][17][18][19][21][22][23][24][25]29,30 followed by nutrition centres (four), 9,11,12,27 EPI centres (three), 20 programmes (three). 8,20,31 The assessment for quality showed that most of the included studies (20) [9][10][11][12][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31] were of fair or good quality and the remainder (six) [6][7][8]13,…”

Section: Resultsmentioning

confidence: 99%

“…We did a stratifi ed analysis of paediatric HIV prevalence in southern and eastern Africa (20 studies) 8,[10][11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][27]28,29 versus that in west and central Africa (four). 9,23,28,31 Paediatric HIV prevalence across contexts in southern and eastern Africa was 17·8% (95% CI 12·8-22·7) and prevalence in west and central Africa was 9·8% (95% CI 4·2-15·3).…”

Section: Resultsmentioning

confidence: 99%

Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis

et al. 2016

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“…In Botswana, approximately half of children diagnosed with TB are reported to have concurrent failure to thrive (including undernutrition and malnutrition) and one study found that 6% of children with failure to thrive had concurrent TB. 10 Failure to thrive is thus a critical red flag for young children in endemic areas and should elicit prompt TB screening. Earlier recognition of failure to thrive may have led to an earlier diagnosis in the case of the infant described.…”

Section: Global Health Problem Analysismentioning

confidence: 99%

Fatal SARS-CoV-2 andMycobacterium tuberculosiscoinfection in an infant: insights from Botswana

et al. 2021

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We report a fatal case of SARS-CoV-2 and Mycobacterium tuberculosis coinfection in an infant, Botswana’s first paediatric COVID-19-associated fatality. The patient, a 3-month-old HIV-unexposed boy, presented with fever and respiratory distress in the setting of failure to thrive. Both the patient and his mother tested positive for rifampin-sensitive M. tuberculosis (Xpert MTB/Rif) and SARS-CoV-2 (real time-PCR). Initially stable on supplemental oxygen and antitubercular therapy, the patient experienced precipitous clinical decline 5 days after presentation and subsequently died. Autopsy identified evidence of disseminated tuberculosis (TB) as well as histopathological findings similar to those described in recent reports of SARS-CoV-2 infections, including diffuse microthrombosis. TB remains a serious public health threat in hyperendemic regions like sub-Saharan Africa, and is often diagnosed late in infants. In addition to raising the question of additive/synergistic pathophysiology and/or immune reconstitution, this case of coinfection also highlights the importance of leveraging the COVID-19 pandemic response to strengthen efforts for TB prevention, screening and detection.

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Yield of Screening for TB and HIV among Children Failing to Thrive in Botswana

Abstract: TB and HIV screening among children with FTT diagnosed TB in 6% of cases completing an evaluation, but no new HIV infections.

Cited by 12 publications

References 9 publications

Outcomes of isoniazid preventive therapy among people living with HIV in Kenya: A retrospective study of routine health care data

Outcomes of isoniazid preventive therapy among people living with HIV in Kenya: A retrospective study of routine health care data

Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis

Fatal SARS-CoV-2 andMycobacterium tuberculosiscoinfection in an infant: insights from Botswana

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