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Title: Tuberculosis in Antiretroviral Treatment Programs in Lower Income Countries: Availability and Use of Diagnostics and Screening
Authors: Lukas Fenner
Marie Ballif
Claire Graber
Venerandah Nhandu
Jean Claude Dusingize
Claudia P. Cortes
Gabriela Carriquiry
Kathryn Anastos
Daniela Garone
Eefje Jong
Joachim Charles Gnokoro
Omar Sued
Samuel Ajayi
Lameck Diero
Kara Wools-Kaloustian
Sasisopin Kiertiburanakul
Barbara Castelnuovo
Charlotte Lewden
Nicolas Durier
Timothy R. Sterling
Matthias Egger
Institut fur Sozial- und Praventivmedizin
Swiss Tropical and Public Health Institute (Swiss TPH)
Universitat Basel
Centre for Infectious Disease Research in Zambia
Women's Equity in Access to Care and Treatment
Facultad de Medicina de la Universidad de Chile
Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt
Albert Einstein College of Medicine of Yeshiva University
Khayelitsha ART Programme
University of Witwatersrand
Fundacion Huesped
University of Abuja
Indiana University-Purdue University Indianapolis
Mahidol University
Infections Diseases Institute
University Bordeaux Segalen
amfAR - The Foundation for AIDS Research
Vanderbilt University School of Medicine
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 17-Oct-2013
Citation: PLoS ONE. Vol.8, No.10 (2013)
Abstract: Objectives:In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries.Methods and findings:We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%).Conclusions:Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge. © 2013 Fenner et al.
ISSN: 19326203
Appears in Collections:Scopus 2011-2015

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