title: Risk factors for inadequate TB case finding in Rural Western Kenya: a comparison of actively and passively identified TB patients.
abstract: BACKGROUND
  The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB), that a quarter of the prevalent cases had not yet sought care, and a low case detection rate.
  
  
  OBJECTIVE
  We aimed to identify factors associated with inadequate case finding among adults with PTB in this population by comparing characteristics of 194 PTB patients diagnosed in a health facility after self-report, i.e., through passive case detection, with 88 patients identified through active case detection during the prevalence survey. We examined associations between method of case detection and patient characteristics, including HIV-status, socio-demographic variables and disease severity in univariable and multivariable logistic regression analyses.
  
  
  RESULTS
  HIV-infection was associated with faster passive case detection in univariable analysis (crude OR 3.5, 95% confidence interval (CI) 2.0-5.9), but in multivariable logistic regression this was largely explained by the presence of cough, illness and clinically diagnosed smear-negative TB (adjusted OR (aOR) HIV 1.8, 95% CI 0.85-3.7). Among the HIV-uninfected passive case detection was less successful in older patients aOR 0.76, 95%CI 0.60-0.97 per 10 years increase), and women (aOR 0.27, 95%CI 0.10-0.73). Reported current or past alcohol use reduced passive case detection in both groups (0.42, 95% CI 0.23-0.79). Among smear-positive patients median durations of cough were 4.0 and 6.9 months in HIV-infected and uninfected patients, respectively.
  
  
  CONCLUSIONS
  HIV-uninfected patients with infectious TB who were older, female, relatively less ill, or had a cough of a shorter duration were less likely found through passive case detection. In addition to intensified case finding in HIV-infected persons, increasing the suspicion of TB among HIV-uninfected women and the elderly are needed to improve TB case detection in Kenya.
authors: University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands. a.h.vanthoog@aighd.org
authors: Anna H
authors: AH
authors: Van't Hoog
authors: Barbara J
authors: BJ
authors: Marston
authors: John G
authors: JG
authors: Ayisi
authors: Janet A
authors: JA
authors: Agaya
authors: Odylia
authors: O
authors: Muhenje
authors: Lazarus O
authors: LO
authors: Odeny
authors: John
authors: J
authors: Hongo
authors: Kayla F
authors: KF
authors: Laserson
authors: Martien W
authors: MW
authors: Borgdorff
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005188:False Negative Reactions; D005260:Female; D015658:HIV Infections / Q000150:complications; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
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