High prevalence of tuberculosis in newly enrolled HIV patients in Zambia: need for enhanced screening approach


Authors

Henostroza G, Harris JB, Chitambi R, Siyambango M, Turnbull ER, Maggard KRKrüüner A, Kapata N, Reid SE.


Journal

Int J Tuberc Lung Dis. 2016 Aug;20(8):1033-9. doi: 10.5588/ijtld.15.0651.


SETTING:

Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. In Zambia, smear microscopy and chest radiography (CXR) are the primary TB diagnostic tools, and most cases are not bacteriologically confirmed.

OBJECTIVE:

We implemented enhanced screening to determine the TB burden among new human immunodeficiency virus (HIV) clinic enrollees.

DESIGN:

Consecutive adult HIV clinic enrollees were screened, regardless of symptoms. All underwent microscopy (Ziehl-Neelsen/fluorescence microscopy) on three sputum specimens, physical examination, and digital CXR. Sputum, blood and urine specimens were cultured. Xpert(®) MTB/RIF testing was performed retrospectively.

RESULTS:

From July 2011 to April 2012, 399 patients were enrolled. The median age was 34.4 years; body mass index was 20.8 kg/m(2), CD4 count was 202 cells/μl and 86% were symptomatic. Culture-confirmed TB was diagnosed in 72/399 (18%) patients; an additional 31/399 (8%) were culture-negative but diagnosed clinically. Symptom screening for any cough, fever, weight loss or night sweats had high sensitivity (95%) but low specificity (14%) for detecting culture-confirmed cases. Among culture-confirmed cases, 35/72 (49%) were missed clinically and detected only by culture. Xpert was 64% sensitive and 98% specific.

CONCLUSIONS:

High TB prevalence was found in Zambians newly enrolled into HIV care. Screening with sensitive diagnostics should be considered with culture when feasible in this population.

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