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Validation of the clinical tuberculosis screening algorithm used in Nigerian national tuberculosis control programme for screening people living with HIV

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DOI: 10.4236/health.2013.511234    4,462 Downloads   5,909 Views  

ABSTRACT

Background: In high HIV prevalence, tuberculosis diagnosis is challenging. Some countries hence use clinical algorithms to screen for tuberculosis in People Living with HIV (PLHIV). Objectives: The aim of the study was to validate the national algorithm for clinical tuberculosis screening of persons living with HIV who attend comprehensive HIV clinics. Methods: A cross-sectional study of PLHIV who presented with cough of at least 2 weeks duration between 2009 and 2011 at St Patrick’s Hospital, Ebonyi State, Nigeria. Sputum smear microscopy for acid fast bacilli was obtained from the participants. Results: Three hundred and twelve PLHIV were studied: 146 (46.8%) males and 166 (53.2%) females. Only 55 (17.6%) of the participants had smear positive pulmonary tuberculosis. Weight loss (c2 = 2.33; P = 0.127), hemoptysis (c2 = 0.03; P = 0.864), night sweats (c2 = 1.52; P = 0.218), fever (c2 = 3.49; P = 0.06), anorexia (c2 = 0.49; P = 0.484), chest pain (c2 = 2.48; P = 0.115), breathlessness (c2 = 0.63; P = 0.426) were not significant in PLHWA with/without pulmonary tuberculosis. Cough, fever, night sweat and weight loss combined gave a sensitivity of 97.0%, specificity of 10.9%, negative predictive value (NPV) of 93.3% and positive predictive value (PPV) of 21.8%. Conclusion: Findings suggest that though national screening algorithm is a valid tool to screen for tuberculosis in PLHIV, it will lead to many false positive results.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Aguwa, E. , Onwasigwe, C. , Chukwu, J. , Oshi, D. , Nwafor, C. , Omotowo, B. , Ndu, A. , Meka, A. , Ekwueme, O. , Ugwunna, N. and Anyim, M. (2013) Validation of the clinical tuberculosis screening algorithm used in Nigerian national tuberculosis control programme for screening people living with HIV. Health, 5, 1737-1741. doi: 10.4236/health.2013.511234.

References

[1] World Health Organization (2011) Global tuberculosis control. WHO Report 2011.
[2] Corbett, E.L., Watt, C.J., Walker, N., et al. (2003) The growing burden of tuberculosis. Global trends and interactions with the HIV epidemic. Archives of Internal Medicine, 163, 1009-1021.
http://dx.doi.org/10.1001/archinte.163.9.1009
[3] Getahun, H., Gunneberg, C., Granich, R. and Nunn, P. (2010) HIV infection-associated tuberculosis: The epidemiology and the response. Clinical Infectious Diseases, 50, S201-S207. http://dx.doi.org/10.1086/651492
[4] Harries, A.D., Hargreaves, N.J., Kemp, J., et al. (2001) Deaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1. Lancet, 357, 1519-1523. http://dx.doi.org/10.1016/S0140-6736(00)04639-0
[5] Rana, F.S., Hawken, M.P., Mwachari, C., et al. (2000) Autopsy study of HIV-1-positive and HIV-1-negative adult medical patients in Nairobi, Kenya. Journal of Acquired Immune Deficiency Syndromes, 24, 23-29.
[6] World Bank (2012) Tuberculosis case detection rate (%, all forms). The World Bank Data.
http://data.worldbank.org/indicator/SH.TBS.DTEC.ZS
[7] Sharma, S.K., Mohan, A. and Kadhiravan, T. (2005) HIV-TB co-infection: Epidemiology, diagnosis & management. Indian Journal of Medical Research, 121, 550-567.
[8] Ha, D.T.M., Lan, N.T.N., Kiet, V.S., Wolbers, M., Hang, H.T.T., Day, J., Hien, N.Q., Tien, N.A., et al. (2010) Diagnosis of pulmonary tuberculosis in HIV-positive patients by microscopic observation drug susceptibility assay. Journal of Clinical Microbiology, 48, 4573-4579.
http://dx.doi.org/10.1128/JCM.00687-10
[9] Sterling, T.R., Pham, P.A. and Chaisson, R.E. (2010) HIV infection-related tuberculosis: Clinical manifestations and treatment. Clinical Infectious Diseases, 50, S223-S230.
http://dx.doi.org/10.1086/651495
[10] Cain, K.P., Anekthanaon, T., Burapat, C., et al. (2009) Causes of death in HIV-infected persons who have tuberculosis, Thailand. Emerging Infectious Diseases, 15, 258-264. http://dx.doi.org/10.3201/eid1502.080942
[11] Conde, M.B., Figueira, C.M., Moraes, R., Fonseca, L.S., DeRiemer, K. and Kritski, L.(1999) Predictive value of acid fast smear for detection of mycobacterium tuberculosis in respiratory specimen in reference center of HIV/ AIDS in Rio de Jeneriro. Memorials do instituto Oswaldo Cruz On-Line, 94, 787-790.
[12] Weber, A.M., Areerat, P., Fischer, J.E., Thamthitiwat, S., Olsen, S.J. and Varma, J.K. (2008) Factors associated with diagnostic evaluation for tuberculosis adults hospitalized with clinical pneumonia in Thailand. Infection Control and Hospital Epidemiology, 29, 648-657.
http://dx.doi.org/10.1086/588684
[13] Tattevin, P., Casalino, E., Fleury, L., Egmann, G., Ruel, M. and Bouvet, E. (1999) The validity of medical history, clinical symptoms and chest radiography in predicting pulmonary tuberculosis. Chest, 115, 1248-1253.
http://dx.doi.org/10.1378/chest.115.5.1248
[14] Were, W., Moore, D., Ekwaru, P., Mwima, G., Bunnell, R., Kaharuza, F., Rutherford, G. and Mermin, J. (2009) A simple screening tool for active tuberculosis in HIV-infected adults receiving antiretroviral treatment in Uganda. The International Journal of Tuberculosis and Lung Disease, 13, 47-53.
[15] Mohammed, A., Ehrlich, R., Wood, R., Cilliers, F. and Maartens G. (2003) Screening for tuberculosis in adults with advanced HIV disease prior to preventive therapy. The International Journal of Tuberculosis and Lung Disease, 8, 792-795.
[16] Samb, B., Henzel, D., Daley, C.L., Mugusi, F., Niyongabo, T., Mlika-Cabanne, N., Aubry, P., Mbaga, I., Larouze, B. and Murray, J.F. (1997) Methods for diagnosing tuberculosis among in-patients in eastern Africa whose sputum smears are negative. The International Journal of Tuberculosis and Lung Disease, 1, 25-30.
[17] Federal Republic of Nigeria (2006) Population census. National Bureau of Statistics. www.nigeriastat.gov.ng
[18] Weyer, K., De Kantor, I.N., Kim, S.J. and Frieden, T. (1998) Laboratory services in tuberculosis control. WHO, Geneva, 43.
[19] Olaniran, O., Hassan-Olajokun, R.E., Oyovwevotu, M.A. and Agunlejika, R.A. (2011) Prevalence of tuberculosis among HIV/AIDS patients in Obafemi Awolowo University Teaching Hospital Complex, ILE-IFE Nigeria. International Journal of Biological & Medical Research, 2, 874-877.
[20] Iliyasu, Z. and Babashani, M. (2009) Prevalence and predictors of tuberculosis co-infection among HIV-seropositive patients attending the Aminu Kano Teaching Hospital, Northern Nigeria. Journal of Epidemiology, 19, 81-87. http://dx.doi.org/10.2188/jea.JE20080026
[21] Kevin, P.C., Kimberly, D.M., Charles, M.H., Patama, M., Theerawit, T. and Nong, K. (2010) An algorithm for TB screening and diagnosis in people with HIV. The New England Journal of Medicine, 362, 31-40.
[22] Getahun, H., Kittikraisak, W., Heilig, C.M., Corbett, E.L., Ayles, H., Cain, K.P., et al. (2011) Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: Individual participant data meta-analysis of observational studies. PLoS Medicine, 8, e1000391.
http://dx.doi.org/10.1371/journal.pmed.1000391

  
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