Population-based chest X-ray screening for pulmonary tuberculosis in people living with HIV/AIDS, An Giang, Vietnam.
METHODS
Human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) program, An Giang Province, Vietnam.


OBJECTIVE
To evaluate the coverage and yield of a chest radiography (CXR) screening program for tuberculosis (TB) among people living with HIV/AIDS (PLHA), risk factors for a TB CXR, inter-rater reliability of CXR readings and direct costs.


METHODS
Retrospective review of routine public health program records and CXRs.


RESULTS
An increasing proportion of PLHAs received a screening CXR each year of the program (range 21% in 2001 to 61% in 2004, P<0.001). Of 876 screening CXRs performed, 191 (22%) were classified as suspicious for active TB ('TB CXR'). Compared to PLHAs with a CXR not suspicious for active TB, PLHAs with a TB CXR were more likely to be aged between 24 and 64 years, male and previously treated for TB (P<0.01 for each comparison). Agreement between the expert and local program CXR readings was 81% (kappa 0.50). Direct costs were approximately US$40 per TB suspect identified. Among TB suspects, <10% were followed up with sputum smear examination and enrolled for treatment.


CONCLUSIONS
In An Giang Province, a large proportion of PLHAs are screened for TB annually, and one in five persons screened is classified as a TB suspect based on CXR. Annual CXRs may be a high-yield, inexpensive method for TB screening in PLHAs, but the follow-up of TB suspects to confirm diagnosis and initiate treatment is crucial.
Shah
N S
NS
Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA. sshah@montefiore.org
Anh
M H
MH
Thuy
T T
TT
Duong Thom
B S
BS
Linh
T
T
Nghia
D T
DT
Sy
D N
DN
Duong
B D
BD
Chau
L T M
LT
Wells
C
C
Laserson
K
K
Varma
J K
JK
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008400:Mass Chest X-Ray / Q000191:economics; D008875:Middle Aged; D015203:Reproducibility of Results; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014744:Vietnam / Q000453:epidemiology