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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Intensified tuberculosis case-finding in HIV-positive adults managed at ethiopian health centers: Diagnostic yield of xpert MTB/RIF compared with smear microscopy and liquid culture
PLoS ONE, Volume 9, No. 1, Article e85478, Year 2014
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Description
Background: Detection of active tuberculosis (TB) before antiretroviral therapy (ART) initiation is important, but optimal diagnostic methods for use in resource-limited settings are lacking. We assessed the prevalence of TB, evaluated the diagnostic yield of Xpert MTB/RIF in comparison with smear microscopy and culture, and the impact of Xpert results on clinical management in HIV-positive adults eligible for ART at health centers in a region of Ethiopia. Methods: Participants were prospectively recruited and followed up at 5 health centers. Trained nurses collected data on socio-demographic characteristics, medical history and symptoms, and performed physical examination. Two paired morning sputum samples were obtained, and lymph node aspirates in case of lymphadenopathy. Diagnostic yield of Xpert MTB/RIF in sputum was compared with smear microscopy and liquid culture. Results: TB was diagnosed in 145/812 participants (17.9%), with bacteriological confirmation in 137 (16.9%). Among bacteriologically confirmed cases, 31 were smear-positive (22.6%), 96 were Xpert-positive (70.1%), and 123 were culture-positive (89.8%). Xpert MTB/RIF increased the TB detection rate by 64 cases (47.4%) compared with smear microscopy. The overall sensitivity of Xpert MTB/RIF was 66.4%, and was not significantly lower when testing one compared with two samples. While Xpert MTB/RIF was 46.7% sensitive among patients with CD4 cell counts >200 cells/mm3, this increased to 82.9% in those with CD4 cell counts ≤100 cells/mm3. Compared with Xpert-positive TB patients, Xpert-negative cases had less advanced HIV and TB disease characteristics. Conclusions: Previously undiagnosed TB is common among HIV-positive individuals managed in Ethiopian health centers. Xpert MTB/RIF increased TB case detection, especially in patients with advanced immunosuppression. An algorithm based on the use of a single morning sputum sample for individuals with negative sputum smear microscopy could be considered for intensified case finding in patients eligible for ART. However, technical and cost-effectiveness issues relevant for low-income countries warrant further study. © 2014 Balcha et al.
Authors & Co-Authors
Balcha, Taye Tolera
Sweden, Malmo
Institutionen För Kliniska Vetenskaper, Malmö
Ethiopia, Addis Ababa
Federal Ministry of Health - Ethiopia
Sturegârd, Erik
Sweden, Malmo
University and Regional Laboratories Region Scania
Winqvist, Niclas
Sweden, Malmo
Institutionen För Kliniska Vetenskaper, Malmö
Sweden, Malmo
Regional Department of Infectious Disease Control and Prevention
Skogmar, Sten
Sweden, Malmo
Institutionen För Kliniska Vetenskaper, Malmö
Reepalu, Anton
Sweden, Malmo
Institutionen För Kliniska Vetenskaper, Malmö
Jemal, Zelalem Habtamu
Ethiopia, Addis Ababa
Oromia Regional Health Bureau
Tibesso, Gudeta
United States, New York
Mailman School of Public Health
Schön, Thomas
Sweden, Linkoping
Linköpings Universitet
Sweden, Kalmar
Kalmar County Hospital
Björkman, Per
Sweden, Malmo
Institutionen För Kliniska Vetenskaper, Malmö
Statistics
Citations: 77
Authors: 9
Affiliations: 8
Identifiers
Doi:
10.1371/journal.pone.0085478
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Ethiopia