title: Intensified tuberculosis case finding among HIV-Infected persons from a voluntary counseling and testing center in Addis Ababa, Ethiopia.
abstract: OBJECTIVE
  To evaluate commonly available screening tests for pulmonary tuberculosis (TB), using sputum bacteriology as a gold standard, in HIV-infected persons attending an urban voluntary counseling and testing clinic in Addis Ababa, Ethiopia.
  
  
  METHODS
  Prospective enrollment of HIV-infected persons, all of whom underwent TB screening, regardless of symptoms, with: (1) symptom screening and physical examination, (2) 3 sputum specimens for smear microscopy, and (3) chest radiograph. One sputum was also sent for concentrated smear microscopy and mycobacterial culture. Chest radiographs were reviewed by 2 independent radiologists. A confirmed TB diagnosis was defined as 1 positive sputum smear and/or 1 positive sputum culture.
  
  
  RESULTS
  We enrolled 438 HIV-infected persons: 265 (61%) females, median age 34 years (range: 18-65), median CD4 cell count 181 cells per cubic millimeter (range: 2-1185). Overall, 32 (7%) persons were diagnosed with TB, of whom 5 (16%) were asymptomatic but culture-confirmed TB cases. Screening for cough >2 weeks would have detected only 12 (38%) confirmed TB cases; screening for cough or fever, of any duration, would have detected 24 (75%) cases, with specificity of 64%. Negative predictive value of screening for these 2 symptoms was 97%. Simulation of the current Ethiopian national guidelines had a sensitivity of 63% and specificity of 83% for diagnosing TB disease among study patients.
  
  
  CONCLUSIONS
  Traditional symptom screening is insufficient for detecting TB disease among HIV-infected persons but may serve to exclude TB disease. More sensitive, rapid, and low-cost diagnostic tests are needed to meet the demand of resource-limited settings.
authors.affiliation: Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, 111 East 210th Street, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. ns597@columbia.edu
authors.forename: Sarita
authors.initials: S
authors.lastname: Shah
authors.forename: Meaza
authors.initials: M
authors.lastname: Demissie
authors.forename: Lauren
authors.initials: L
authors.lastname: Lambert
authors.forename: Jelaludin
authors.initials: J
authors.lastname: Ahmed
authors.forename: Sileshi
authors.initials: S
authors.lastname: Leulseged
authors.forename: Tekeste
authors.initials: T
authors.lastname: Kebede
authors.forename: Zenebe
authors.initials: Z
authors.lastname: Melaku
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Mengistu
authors.forename: Eshetu
authors.initials: E
authors.lastname: Lemma
authors.forename: Charles D
authors.initials: CD
authors.lastname: Wells
authors.forename: Tadesse
authors.initials: T
authors.lastname: Wuhib
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult