title: A simple screening tool for active tuberculosis in HIV-infected adults receiving antiretroviral treatment in Uganda.
abstract: METHODS
  Reliable clinical algorithms that screen for active tuberculosis (TB) in human immunodeficiency virus (HIV) infected people initiating or receiving antiretroviral treatment (ART) in sub-Saharan Africa could reduce the need for diagnostic procedures.
  
  
  METHODS
  We estimated the utility of six TB-related signs and symptoms, alone or in combination, compared with the Uganda Ministry of Health diagnostic guidelines for participants with prevalent (baseline), early ART (< or = 3 months on ART) and incident TB (>3 months on ART).
  
  
  RESULTS
  Of 1995 participants screened for ART eligibility, 71 (3.6%) had prevalent TB. The presence of any one of the following: cough > or = 3 weeks, fever > or = 4 weeks, lymphadenopathy or baseline body mass index < or = 18 kg/m(2) had a sensitivity of 99% (95%CI 96-100), a specificity of 66% (95%CI 64-68) and a negative predictive value (NPV) of 100% (95%CI 99-100) for predicting active TB. During ART follow-up, TB incidence was 2.4 (95%CI 1.6-3.4)/100 person-years. The presence of cough > or = 3 weeks or general weakness was 100% sensitive (95%CI 99-100), 66% specific (95%CI 59-74) and had an NPV of 100% (95%CI 99-100).
  
  
  CONCLUSIONS
  Use of a simple TB screening algorithm can accurately identify, in a resource-poor African setting, HIV-infected individuals who require further procedures to diagnose active TB.
authors.affiliation: Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Uganda, Entebbe, Uganda. wgw7@ug.cdc.gov
authors.forename: W
authors.initials: W
authors.lastname: Were
authors.forename: D
authors.initials: D
authors.lastname: Moore
authors.forename: P
authors.initials: P
authors.lastname: Ekwaru
authors.forename: G
authors.initials: G
authors.lastname: Mwima
authors.forename: R
authors.initials: R
authors.lastname: Bunnell
authors.forename: F
authors.initials: F
authors.lastname: Kaharuza
authors.forename: G
authors.initials: G
authors.lastname: Rutherford
authors.forename: J
authors.initials: J
authors.lastname: Mermin
mesh_terms: D000328:Adult; D000465:Algorithms; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012424:Rural Population / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents