Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya.
Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya.
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DOI：
10.1371/journal.pone.0167685
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Cain KP
中科院分区：
文献类型：
--
作者：
Modi S;Cavanaugh JS;Shiraishi RW;Alexander HL;McCarthy KD;Burmen B;Muttai H;Heilig CM;Nakashima AK;Cain KP
评估肯尼亚西部艾滋病毒感染者（包括孕妇）中单独和联合胸部X光检查的结核病（TB）筛查效果。前瞻性队列研究来自15个随机选择的HIV诊所的PLHIV使用三种临床算法[世界卫生组织（WHO）、卫生部（MOH）和“改善HIV感染者的结核病诊断”（ID-TB/HIV）研究]进行筛查，接受胸部X线摄影（除非怀孕），并提供两份或更多痰液标本用于涂片显微镜检查、液体培养和Xpert MTB/RIF。临床筛选的性能进行了比较，实验室结果，控制复杂的调查设计。总体而言，862名PLHIV患者中的738名（85.6%）被纳入分析。估计结核病患病率为11.2%（95% CI，9.9-12.7）。三种筛查算法的灵敏度相似[WHO，74.1%（95% CI，64.1-82.2）; MOH，77.5%（95% CI，68.6-84.5）; ID-TB/HIV，72.5%（95% CI，60.9-81.7）]。与非妊娠女性[78.3%（95% CI，67.3-86.4）]和男性[77.2%（95% CI，68.3 -84.2）]相比，HIV感染妊娠女性[28.2%（95% CI，14.9-46.7）]中WHO算法的灵敏度显著较低。在无症状男性和非妊娠女性中，胸部X线摄影将WHO算法敏感性和阴性预测值分别提高至90.9%（95%CI，86.4-93.9）和96.1%（95%CI，94.4-97.3）。在所有艾滋病毒感染者中，临床筛查漏诊了约25%的实验室确诊结核病例，在艾滋病毒感染的孕妇中漏诊了70%以上。国家艾滋病规划应评估基于实验室的结核病筛查的可行性，例如在参加艾滋病服务时对所有艾滋病毒感染者，特别是孕妇进行单一Xpert MTB/RIF检测。
To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya. Prospective cohort study PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and “Improving Diagnosis of TB in HIV-infected persons” (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey. Overall, 738 (85.6%) of 862 PLHIV enrolled were included in the analysis. Estimated TB prevalence was 11.2% (95% CI, 9.9–12.7). Sensitivity of the three screening algorithms was similar [WHO, 74.1% (95% CI, 64.1–82.2); MOH, 77.5% (95% CI, 68.6–84.5); and ID-TB/HIV, 72.5% (95% CI, 60.9–81.7)]. Sensitivity of the WHO algorithm was significantly lower among HIV-infected pregnant women [28.2% (95% CI, 14.9–46.7)] compared to non-pregnant women [78.3% (95% CI, 67.3–86.4)] and men [77.2% (95% CI, 68.3–84.2)]. Chest radiography increased WHO algorithm sensitivity and negative predictive value to 90.9% (95% CI, 86.4–93.9) and 96.1% (95% CI, 94.4–97.3), respectively, among asymptomatic men and non-pregnant women. Clinical screening missed approximately 25% of laboratory-confirmed TB cases among all PLHIV and more than 70% among HIV-infected pregnant women. National HIV programs should evaluate the feasibility of laboratory-based screening for TB, such as a single Xpert MTB/RIF test for all PLHIV, especially pregnant women, at enrollment in HIV services.
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DOI：
10.1093/infdis/jir411
发表时间：
2011-11-15
期刊：
The Journal of infectious diseases
影响因子：
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10.1097/qai.0b013e31821ac9c1
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2011-08-01
影响因子：
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