title: Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening.
abstract: OBJECTIVE
  In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries.
  
  
  RESULTS
  We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%).
  
  
  CONCLUSIONS
  Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland ; Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Fenner
authors.forename: Marie
authors.initials: M
authors.lastname: Ballif
authors.forename: Claire
authors.initials: C
authors.lastname: Graber
authors.forename: Venerandah
authors.initials: V
authors.lastname: Nhandu
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Dusingize
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Cortes
authors.forename: Gabriela
authors.initials: G
authors.lastname: Carriquiry
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Daniela
authors.initials: D
authors.lastname: Garone
authors.forename: Eefje
authors.initials: E
authors.lastname: Jong
authors.forename: Joachim Charles
authors.initials: JC
authors.lastname: Gnokoro
authors.forename: Omar
authors.initials: O
authors.lastname: Sued
authors.forename: Samuel
authors.initials: S
authors.lastname: Ajayi
authors.forename: Lameck
authors.initials: L
authors.lastname: Diero
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloustian
authors.forename: Sasisopin
authors.initials: S
authors.lastname: Kiertiburanakul
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D005260:Female; D005843:Geography; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents