title: Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding.
abstract: BACKGROUND
  The World Health Organization strongly recommends regular screening for tuberculosis (TB) in HIV-positive individuals.
  
  
  OBJECTIVE
  To compare the outcome of anti-tuberculosis treatment (ATT) in HIV-positive adults diagnosed with TB through active case-finding (ACF) or passive case-finding (PCF).
  
  
  METHODS
  Antiretroviral therapy (ART)-naïve adults diagnosed with TB were included from two prospective cohort studies conducted in Ethiopia between September 2010 and March 2013. The PCF cohort was based at out-patient TB clinics, whereas participants in the ACF cohort were actively screened for TB by bacteriological sputum testing (smear microscopy, Xpert MTB/RIF assay, and liquid culture) without pre-selection on the basis of symptoms and signs. Outcomes of ATT were compared between participants in the two cohorts; characteristics at diagnosis and predictors of adverse outcomes were analysed.
  
  
  RESULTS
  Among 439 TB/HIV co-infected participants, 307 and 132 belonged to PCF and ACF cohorts, respectively. Compared with the ACF participants, hemoptysis, conjunctival pallor, bedridden status, and low mid upper-arm circumference (MUAC) were significantly more common in participants identified through PCF. Sputum smear-positivity rates among pulmonary TB cases were 44.2% and 21.1% in the PCF and ACF cohorts, respectively (p<0.001). Treatment success was ascertained in 247 (80.5%) of the participants in the PCF cohort and 102 (77.2%) of the participants in the ACF cohorts (p=0.223). Low MUAC (p=0.001) independently predicted mortality in the participants in both cohorts.
  
  
  CONCLUSIONS
  Although patients identified through ACF had less advanced TB disease, ATT outcome was similar to the patients identified through PCF. To achieve a better outcome, case management in ACF strategy should be strengthened through enhanced patient-centred counselling and adherence support.
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.|Ministry of Health, Addis Ababa, Ethiopia; tayetolera@yahoo.com.
authors.forename: Taye T
authors.initials: TT
authors.lastname: Balcha
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Sten
authors.initials: S
authors.lastname: Skogmar
authors.affiliation: Clinical Microbiology, Regional and University Laboratories, Region Skåne, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Sturegård
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Björkman
authors.affiliation: Infectious Disease Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.|Regional Department of Infectious Disease Control and Prevention, Malmö, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Winqvist
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D019090:Case Management / Q000458:organization & administration*; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D042241:Early Diagnosis; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000458:organization & administration; D011446:Prospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents
keywords: HIV; TB; active case-finding; adverse treatment outcomes; passive case-finding
references.citation: Am J Respir Crit Care Med. 2013 Mar 1;187(5):543-51
references.pmid: 23262515
references.citation: Epidemiol Infect. 2008 Oct;136(10):1342-9
references.pmid: 18177518
references.citation: AIDS. 2010 Jun 1;24(9):1323-8
references.pmid: 20386425
references.citation: Lancet Infect Dis. 2010 Feb;10(2):93-102
references.pmid: 20113978
references.citation: PLoS Med. 2012;9(8):e1001281
references.pmid: 22879816
references.citation: Open Forum Infect Dis. 2014 Oct 10;1(3):ofu095
references.pmid: 25734163
references.citation: BMC Public Health. 2014;14:52
references.pmid: 24438508
references.citation: PLoS One. 2014;9(3):e92754
references.pmid: 24675985
references.citation: Lancet Infect Dis. 2003 May;3(5):288-96
references.pmid: 12726978
references.citation: Int J Tuberc Lung Dis. 2013 Apr;17(4):432-46
references.pmid: 23485377
references.citation: Int J Tuberc Lung Dis. 2013 Apr;17(4):532-9
references.pmid: 23485388
references.citation: Proc Am Thorac Soc. 2011 Jun;8(3):288-93
references.pmid: 21653530
references.citation: PLoS One. 2014;9(1):e85478
references.pmid: 24465572
references.citation: Clin Infect Dis. 2010 Oct 1;51(7):823-9
references.pmid: 20735240
references.citation: Trop Med Int Health. 2012 Dec;17(12):1527-33
references.pmid: 23130871
references.citation: Int J Tuberc Lung Dis. 2005 Nov;9(11):1183-203
references.pmid: 16333924
references.citation: PLoS Med. 2007 Feb;4(2):e37
references.pmid: 17298164
references.citation: Glob Health Action. 2014;7:23105
references.pmid: 24560255
references.citation: Int J Tuberc Lung Dis. 1998 Sep;2(9 Suppl 1):S9-15
references.pmid: 9755959
references.citation: Lancet Infect Dis. 2009 Mar;9(3):173-84
references.pmid: 19246021
references.citation: Infection. 2007 Apr;35(2):69-80
references.pmid: 17401710
references.citation: Tuberculosis (Edinb). 2003;83(1-3):68-76
references.pmid: 12758192
references.citation: Int J Tuberc Lung Dis. 2008 Jul;12(7):773-9
references.pmid: 18544203
references.citation: Clin Infect Dis. 2012 Jan 15;54(2):275-81
references.pmid: 22156847
references.citation: Clin Infect Dis. 2010 May 15;50 Suppl 3:S238-44
references.pmid: 20397954
references.citation: PLoS One. 2012;7(9):e45704
references.pmid: 23049842