'Cough officer' nurses in a general medical clinic successfully detect drug-susceptible and -resistant tuberculosis.
METHODS
Intensive case finding (ICF) for tuberculosis (TB) is recommended by the World Health Organization among known human immunodeficiency virus (HIV) patients. However, ICF may also be appropriate in generalized patient populations.


OBJECTIVE
To evaluate the yield of ICF in a general medical clinic in a high HIV prevalence setting.


METHODS
A nurse designated as a 'cough officer' identified clinic attendees with cough of >2 weeks and collected sputum for evaluation at the hospital and provincial referral laboratories. We retrospectively evaluated the number and proportion of patients with microbiologically confirmed TB identified in 2007-2008.


RESULTS
Among 56 207 clinic attendees, 1442 (2.6%) TB suspects were identified and 122 (8.5%) were sputum Ziehl-Neelsen (ZN) positive. Of 389 available results, 72 (18.5%) were auramine-positive and 99 (25.4%) were culture-positive; multidrug-resistant and extensively drug-resistant TB were identified in 16 (16.2%). The number needed to screen was 11.8 patients to identify one ZN-positive case and 3.9 to identify one culture-positive case.


CONCLUSIONS
A nurse-facilitated cough officer program successfully identified TB suspects and drug-susceptible and drug-resistant TB. Culture was more sensitive for TB screening and critical for identifying drug resistance. ICF is operationally feasible, and should be expanded to general medical clinics in high HIV and TB prevalence, resource-limited settings.
Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA.
S V
SV
Shenoi
Philanjalo Care Centre, Tugela Ferry, South Africa.
R P
RP
Brooks
Church of Scotland Hospital, Tugela Ferry, South Africa.
K
K
Catterick
Church of Scotland Hospital, Tugela Ferry, South Africa.
A P
AP
Moll
Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA.
G H
GH
Friedland
HIV; South Africa; intensive case finding; rural