Evidence map›Paper›PMID 33632173›Full record

ArticleBMC infectious diseases2021

Pulmonary tuberculosis screening in anti-retroviral treated adults living with HIV in Kenya.

Jill K Gersh, Ruanne V Barnabas, Daniel Matemo, John Kinuthia, Zachary Feldman, Sylvia M Lacourse, Jerphason Mecha, Alex J Warr, Maureen Kamene, David J Horne

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
1.1field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 12 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 2 countries.

Jill K GershDepartment of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
Ruanne V BarnabasDepartment of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
Daniel MatemoDepartment of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya.
John KinuthiaDepartment of Global Health, University of Washington, 325 9th Ave, Box 359762, Seattle, WA, 98102, USA.
Zachary FeldmanAlbers School of Business and Economics, Seattle University, Seattle, WA, USA.
Sylvia M LacourseDepartment of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
Jerphason MechaDepartment of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya.
Alex J WarrDepartment of Pediatrics, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Maureen KameneNational Tuberculosis, Leprosy, and Lung Disease Program, Nairobi, Kenya.
David J HorneDepartment of Global Health, University of Washington, 325 9th Ave, Box 359762, Seattle, WA, 98102, USA. dhorne@uw.edu.
University of Washington · USBaylor College of Medicine · USKenyatta National Hospital · KEMaseno University · KESeattle University · US

Funding

Impact of maternal HIV on Mycobacterium tuberculosis infection among peripartum women and their infantsK23AI120793 · NIAID · UNIVERSITY OF WASHINGTON · PI LACOURSE, SYLVIA · 2016 to 2020
$910k
NIAID NIH HHS K23 AI120793
6 · The paper itself

Abstract

backgroundPeople living with HIV (PLHIV) who reside in high tuberculosis burden settings remain at risk for tuberculosis disease despite treatment with anti-retroviral therapy and isoniazid preventive therapy (IPT). The performance of the World Health Organization (WHO) symptom screen for tuberculosis in PLHIV receiving anti-retroviral therapy is sub-optimal and alternative screening strategies are needed.

methodsWe enrolled HIV-positive adults into a prospective study in western Kenya. Individuals who were IPT-naïve or had completed IPT > 6 months prior to enrollment were eligible. We evaluated tuberculosis prevalence overall and by IPT status. We assessed the accuracy of the WHO symptom screen, GeneXpert MTB/RIF (Xpert), and candidate biomarkers including C-reactive protein (CRP), hemoglobin, erythrocyte sedimentation rate (ESR), and monocyte-to-lymphocyte ratio for identifying pulmonary tuberculosis. Some participants were evaluated at 6 months post-enrollment for tuberculosis.

resultsThe study included 383 PLHIV, of whom > 99% were on antiretrovirals and 88% had received IPT, completed a median of 1.1 years (IQR 0.8-1.55) prior to enrollment. The prevalence of pulmonary tuberculosis at enrollment was 1.3% (n = 5, 95% CI 0.4-3.0%): 4.3% (0.5-14.5%) among IPT-naïve and 0.9% (0.2-2.6%) among IPT-treated participants. The sensitivity of the WHO symptom screen was 0% (0-52%) and specificity 87% (83-90%). Xpert and candidate biomarkers had poor to moderate sensitivity; the most accurate biomarker was CRP ≥ 3.3 mg/L (sensitivity 80% (28-100) and specificity 72% (67-77)). Six months after enrollment, the incidence rate of pulmonary tuberculosis following IPT completion was 0.84 per 100 person-years (95% CI, 0.31-2.23).

conclusionsIn Kenyan PLHIV treated with IPT, tuberculosis prevalence was low at a median of 1.4 years after IPT completion. WHO symptoms screening, Xpert, and candidate biomarkers were insensitive for identifying pulmonary tuberculosis in antiretroviral-treated PLHIV.

Indexed as

AdultAIDS-Related Opportunistic InfectionsAnti-Retroviral AgentsAntitubercular AgentsFemaleHumansIsoniazidKenyaMaleMass ScreeningMiddle AgedPrevalenceProspective StudiesTuberculosis, PulmonaryAnti-Retroviral AgentsAntitubercular AgentsIsoniazidAIDS-related opportunistic infections epidemiologyDiagnostic testsLatent TuberculosisPrevalenceTuberculosis

Identifiers

PMID33632173
PMCPMC7908695
OpenAlexW3132484889

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.