Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya

• Published in: PloS one Vol. 11; no. 12; p. e0167685
• Main Authors: Modi, Surbhi, Cavanaugh, Joseph S., Shiraishi, Ray W., Alexander, Heather L., McCarthy, Kimberly D., Burmen, Barbara, Muttai, Hellen, Heilig, Chad M., Nakashima, Allyn K., Cain, Kevin P.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.12.2016; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Algorithms; Analysis; Biology and Life Sciences; Care and treatment; Chest; Comparative analysis; Diagnosis; Disease control; Feasibility studies; Female; Health aspects; HIV; HIV Infections - complications; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Kenya - epidemiology; Lentivirus; Liquid culture; Male; Mass Chest X-Ray; Medical diagnosis; Medicine and Health Sciences; Microscopy; Middle Aged; Mycobacterium; People and Places; Performance assessment; Physical Sciences; Pregnancy; Pregnant women; Prospective Studies; Radiography; Research and Analysis Methods; Retroviridae; Screening; Sensitivity; Smear; Sputum; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - epidemiology; Womens health; Young Adult; Kenya; Atlanta Georgia; United States > US; Africa; South Africa; Georgia; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0167685

To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya. Prospective cohort study. PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and "Improving Diagnosis of TB in HIV-infected persons" (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey. Overall, 738 (85.6%) of 862 PLHIV enrolled were included in the analysis. Estimated TB prevalence was 11.2% (95% CI, 9.9-12.7). Sensitivity of the three screening algorithms was similar [WHO, 74.1% (95% CI, 64.1-82.2); MOH, 77.5% (95% CI, 68.6-84.5); and ID-TB/HIV, 72.5% (95% CI, 60.9-81.7)]. Sensitivity of the WHO algorithm was significantly lower among HIV-infected pregnant women [28.2% (95% CI, 14.9-46.7)] compared to non-pregnant women [78.3% (95% CI, 67.3-86.4)] and men [77.2% (95% CI, 68.3-84.2)]. Chest radiography increased WHO algorithm sensitivity and negative predictive value to 90.9% (95% CI, 86.4-93.9) and 96.1% (95% CI, 94.4-97.3), respectively, among asymptomatic men and non-pregnant women. Clinical screening missed approximately 25% of laboratory-confirmed TB cases among all PLHIV and more than 70% among HIV-infected pregnant women. National HIV programs should evaluate the feasibility of laboratory-based screening for TB, such as a single Xpert MTB/RIF test for all PLHIV, especially pregnant women, at enrollment in HIV services.