ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2010
Intensive tuberculosis screening for HIV-infected patients starting antiretroviral therapy in Durban, South Africa.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 83 papers, 3 of them syntheses that pooled it.
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Who cites it
83 citing papers in PubMed, 3 syntheses or guidelines pooled it, 136 citations in OpenAlex.
- Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review.BMC infectious diseases · 2021Pooled it
- Pooled it
- Pooled it
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- Subclinical tuberculosis among adults with HIV: clinical features and outcomes in a South African cohort.BMC infectious diseases · 2019Trial
- Implementation of a pragmatic, stepped-wedge cluster randomized trial to evaluate impact of Botswana's Xpert MTB/RIF diagnostic algorithm on TB diagnostic sensitivity and early antiretroviral therapy mortality.BMC infectious diseases · 2016Trial
- Missed Opportunities for TB Investigation in Primary Care Clinics in South Africa: Experience from the XTEND Trial.PloS one · 2015Trial
- A randomized trial to optimize HIV/TB care in South Africa: design of the Sizanani trial.BMC infectious diseases · 2013Trial
- High diagnostic yield of tuberculosis from screening urine samples from HIV-infected patients with advanced immunodeficiency using the Xpert MTB/RIF assay.Journal of acquired immune deficiency syndromes (1999) · 2012Trial
- Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: a prospective study.PLoS medicine · 2011Trial
- Potential Utility of C-reactive Protein for Tuberculosis Risk Stratification Among Patients With Non-Meningitic Symptoms at HIV Diagnosis in Low- and Middle-income Countries.Open forum infectious diseases · 2024Article
- Contributions of GeneXpertThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2022Article
- Incidence and predictors of tuberculosis among HIV patients after initiation of antiretroviral treatment in Ethiopia: a systematic review and meta-analysis.Tropical medicine and health · 2021Article
- Effectiveness of GeneXpert® in the diagnosis of tuberculosis in people living with HIV/AIDS.Revista de saude publica · 2021Review
- Diagnostic yield of active case finding for tuberculosis at human immunodeficiency virus testing in Haiti.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019Article
- HIV-related tuberculosis: mortality risk in persons without vs. with culture-confirmed disease.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019Article
- Advances in the understanding of Mycobacterium tuberculosis transmission in HIV-endemic settings.The Lancet. Infectious diseases · 2019Review
- Improving Tuberculosis Case Finding in Persons Living with Advanced HIV through New Diagnostic Algorithms.American journal of respiratory and critical care medicine · 2019Article
- Article
- The Impact of Anti-Retroviral Therapy on Tuberculosis Detection at the National Level in South Africa.The American journal of tropical medicine and hygiene · 2018Article
23 more citing papers are in PubMed but not listed here.
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundThe World Health Organization (WHO) recommends cough as the trigger for tuberculosis screening in human immunodeficiency virus (HIV)-infected patients, with acid-fast bacillus (AFB) smear as the initial diagnostic test. Our objective was to assess the yield and cost of a more intensive tuberculosis screening in HIV-infected patients starting antiretroviral therapy (ART) in Durban, South Africa.
methodsWe prospectively enrolled adults, regardless of tuberculosis signs/symptoms, who were undergoing ART training from May 2007 to May 2008. After the symptom screen, patients expectorated sputum for AFB smear, tuberculosis polymerase chain reaction (PCR), and mycobacterial culture. Sensitivity and specificity of different symptoms and tests, alone and in combination, were compared with the reference standard of 6-week tuberculosis culture results. Program costs included personnel, materials, and cultures.
resultsOf 1035 subjects, 487 (59%) were female; median CD4 cell count was 100 cells/microL. A total of 210 subjects (20%) were receiving tuberculosis treatment and were excluded. Of the remaining 825 subjects, 158 (19%) had positive sputum cultures, of whom 14 (9%) had a positive AFB smear and 82 (52%) reported cough. The combination of cough, other symptoms, AFB smear, and chest radiograph had 93% sensitivity (95% confidence interval, 88%-97%) and 15% specificity (95% confidence interval, 13%-18%). The incremental cost of intensive screening including culture was $360 per additional tuberculosis case identified.
conclusionsNearly 20% of patients starting ART in Durban, South Africa, had undiagnosed, culture-positive pulmonary tuberculosis. Despite WHO recommendations, neither cough nor AFB smear were adequately sensitive for screening. Tuberculosis sputum cultures should be performed before ART initiation, regardless of symptoms, in areas with a high prevalence of HIV and tuberculosis.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.