Lukas FennerMarie BallifClaire GraberVenerandah NhanduJean Claude DusingizeClaudia P. CortesGabriela CarriquiryKathryn AnastosDaniela GaroneEefje JongJoachim Charles GnokoroOmar SuedSamuel AjayiLameck DieroKara Wools-KaloustianSasisopin KiertiburanakulBarbara CastelnuovoCharlotte LewdenNicolas DurierTimothy R. SterlingMatthias EggerInstitut fur Sozial- und PraventivmedizinSwiss Tropical and Public Health Institute (Swiss TPH)Universitat BaselCentre for Infectious Disease Research in ZambiaWomen's Equity in Access to Care and TreatmentFacultad de Medicina de la Universidad de ChileUniversidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von HumboldtAlbert Einstein College of Medicine of Yeshiva UniversityKhayelitsha ART ProgrammeUniversity of WitwatersrandCEPREF ART ProgramFundacion HuespedUniversity of AbujaUSAID AMPATHIndiana University-Purdue University IndianapolisMahidol UniversityInfections Diseases InstituteUniversity Bordeaux SegalenamfAR - The Foundation for AIDS ResearchVanderbilt University School of Medicine2018-10-192018-10-192013-10-17PLoS ONE. Vol.8, No.10 (2013)193262032-s2.0-84885788916https://repository.li.mahidol.ac.th/handle/20.500.14594/30967Objectives: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.Mahidol UniversityAgricultural and Biological SciencesBiochemistry, Genetics and Molecular BiologyArticleSCOPUS10.1371/journal.pone.0077697