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

Fenner, Lukas and Ballif, Marie and Graber, Claire and Nhandu, Venerandah and Dusingize, Jean Claude and Cortes, Claudia P. and Carriquiry, Gabriela and Anastos, Kathryn and Garone, Daniela and Jong, Eefje and Gnokoro, Joachim Charles and Sued, Omar and Ajayi, Samuel and Diero, Lameck and Wools-Kaloustian, Kara and Kiertiburanakul, Sasisopin and Castelnuovo, Barbara and Lewden, Charlotte and Durier, Nicolas and Sterling, Timothy R. and Egger, Matthias and International epidemiological Databases to Evaluate Aids, . (2013) Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening. PloS one, Vol. 8, H. 10 , e77697.

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Official URL: http://edoc.unibas.ch/dok/A6194535

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Abstract

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.; 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 (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). 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%).; 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.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medical Parasitology and Infection Biology > Tuberculosis Research (Gagneux)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Fenner, Lukas and Ballif, Marie
Item Type:Article, refereed
Bibsysno:Link to catalogue
Publisher:Public Library of Science
ISSN:1932-6203
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
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Last Modified:31 Dec 2015 10:54
Deposited On:27 Feb 2014 15:45

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