title: Symptom screen: diagnostic usefulness in detecting pulmonary tuberculosis in HIV-infected pregnant women in Kenya.
abstract: OBJECTIVE
  To determine the diagnostic usefulness of tuberculosis (TB) symptom screening to detect active pulmonary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for International Development-Academic Model Providing Access to Healthcare partnership.
  
  
  METHODS
  Cross-sectional study. Participants were interviewed for TB symptoms with a standardized questionnaire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted sputum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gestation underwent shielded chest radiography (CXR).
  
  
  RESULTS
  Of 187 HIV-infected women, 38 (20%) were symptom screen-positive. Of these, 21 had a cough for >2 weeks, but all had negative sputum smears and mycobacterial cultures. CXRs were performed in 26 symptomatic women: three were suggestive of TB (1 miliary, 1 infiltrates and 1 cavitary). Of 149 women with a negative symptom screen, 100 had a CXR and seven had a CXR suggestive of TB (1 cavitary, 2 miliary and 4 infiltrates).
  
  
  CONCLUSIONS
  This study did not support the utility of isolated symptom screening in identification of TB disease in our PMTCT setting. CXR was useful in identification of TB suspects in both symptomatic and asymptomatic women.
authors.affiliation: The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; University of Nairobi School of Medicine, Nairobi, Kenya.
authors.forename: R J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: University of Nairobi School of Medicine, Nairobi, Kenya ; Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: P M
authors.initials: PM
authors.lastname: Ndavi
authors.affiliation: University of Nairobi School of Medicine, Nairobi, Kenya ; Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: J O
authors.initials: JO
authors.lastname: Ong'ech
authors.affiliation: The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya.
authors.forename: J M
authors.initials: JM
authors.lastname: Abuya
authors.affiliation: The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya.
authors.forename: A M
authors.initials: AM
authors.lastname: Siika
authors.affiliation: The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: K
authors.initials: K
authors.lastname: Wools-Kaloustian
authors.affiliation: The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya.
authors.forename: H
authors.initials: H
authors.lastname: Mabeya
authors.affiliation: Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: T
authors.initials: T
authors.lastname: Fojo
authors.affiliation: The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya.
authors.forename: A
authors.initials: A
authors.lastname: Mwangi
authors.affiliation: Operational Research Unit, Médecins Sans Frontières-Operational Centre Brussels, Luxembourg.
authors.forename: T
authors.initials: T
authors.lastname: Reid
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: M E
authors.initials: ME
authors.lastname: Edginton
authors.affiliation: The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Carter
keywords: HIV-infected; pregnant; symptom screening; tuberculosis