Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening.

Fenner L, Ballif M, Graber C, Nhandu V, Dusingize JC, Cortes CP, Carriquiry G, Anastos K, Garone D, Jong E, Gnokoro JC, Sued O, Ajayi S, Diero L, Wools-Kaloustian K, Kiertiburanakul S, Castelnuovo B, Lewden C, Durier N, Sterling TR, Egger M, International epidemiological Databases to Evaluate AIDS (IeDEA)
PLoS One. 2013 8 (10): e77697

PMID: 24147059 · PMCID: PMC3798412 · DOI:10.1371/journal.pone.0077697

OBJECTIVES - In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries.

METHODS AND FINDINGS - We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (pā€Š=ā€Š0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (pā€Š=ā€Š0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%).

CONCLUSIONS - Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.

MeSH Terms (11)

Adult Africa South of the Sahara Anti-Retroviral Agents Asia Female Geography Humans Latin America Male Surveys and Questionnaires Tuberculosis

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