title: Yield of undetected tuberculosis and human immunodeficiency virus coinfection from active case finding in urban Uganda.
abstract: OBJECTIVE
  To determine the yield of undetected active tuberculosis (TB), TB and human immunodeficiency virus (HIV) coinfection and the number needed to screen (NNS) to detect a case using active case finding (ACF) in an urban community in Kampala, Uganda.
  
  
  METHODS
  In a door-to-door survey conducted in Rubaga community from January 2008 to June 2009, residents aged ≥15 years were screened for chronic cough (≥2 weeks) and tested for TB disease using smear microscopy and/or culture. Rapid testing was used to screen for HIV infection. The NNS to detect one case was calculated based on population screened and undetected cases found.
  
  
  RESULTS
  Of 5102 participants, 3868 (75.8%) were females; the median age was 24 years (IQR 20-30). Of 199 (4%) with chronic cough, 160 (80.4%) submitted sputum, of whom 39 (24.4%, 95%CI 17.4-31.5) had undetected active TB and 13 (8.1%, 95%CI 6.7-22.9) were TB-HIV co-infected. The NNS to detect one TB case was 131 in the whole study population, but only five among the subgroup with chronic cough.
  
  
  CONCLUSIONS
  ACF obtained a high yield of previously undetected active TB and TB-HIV cases. The NNS in the general population was 131, but the number needed to test in persons with chronic cough was five. These findings suggest that boosting the identification of persons with chronic cough may increase the overall efficiency of TB case detection at a community level.
authors.affiliation: College of Public Health, University of Georgia, Athens, Georgia, USA; and School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: J N
authors.initials: JN
authors.lastname: Sekandi
authors.affiliation: Yale Primary Care Program, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: J
authors.initials: J
authors.lastname: List
authors.affiliation: Department of Clinical Services, Ministry of Health, Kampala, Uganda.
authors.forename: H
authors.initials: H
authors.lastname: Luzze
authors.affiliation: College of Public Health, University of Georgia, Athens, Georgia, USA.
authors.forename: X-P
authors.initials: XP
authors.lastname: Yin
authors.affiliation: College of Public Health, University of Georgia, Athens, Georgia, USA.
authors.forename: K
authors.initials: K
authors.lastname: Dobbin
authors.affiliation: College of Public Health, University of Georgia, Athens, Georgia, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Corso
authors.affiliation: College of Public Health, University of Georgia, Athens, Georgia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Oloya
authors.affiliation: National TB Treatment Center, School of Medicine, Makerere University, Mulago, Uganda.
authors.forename: A
authors.initials: A
authors.lastname: Okwera
authors.affiliation: College of Public Health, University of Georgia, Athens, Georgia, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Whalen
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D060085:Coinfection; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011237:Predictive Value of Tests; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D014454:Uganda / Q000453:epidemiology; D014504:Urban Health; D055815:Young Adult