A simple screening tool for active tuberculosis in HIV-infected adults receiving antiretroviral treatment in Uganda.
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.
Were
W
W
Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Uganda, Entebbe, Uganda. wgw7@ug.cdc.gov
Moore
D
D
Ekwaru
P
P
Mwima
G
G
Bunnell
R
R
Kaharuza
F
F
Rutherford
G
G
Mermin
J
J
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
D044966:Anti-Retroviral Agents