title: Intensified tuberculosis case finding among HIV-infected persons using a WHO symptom screen and Xpert(®) MTB/RIF.
abstract: METHODS
  Human immunodeficiency virus (HIV) clinic in Addis Ababa, Ethiopia. The World Health Organization (WHO) recommends active tuberculosis (TB) case-finding among people living with HIV (PLHIV) in high-burden settings.
  
  
  OBJECTIVE
  To evaluate the effectiveness of combining a WHO-recommended symptom screen and the Xpert(®) MTB/RIF test to enhance TB case finding.
  
  
  METHODS
  In this cross-sectional study, PLHIV were screened for TB using a WHO-recommended symptom-based algorithm (cough, fever, night sweats, weight loss). Those with a positive symptom screen (⩾1 symptom) underwent diagnostic testing with smear microscopy, culture, and Xpert.
  
  
  RESULTS
  Of 828 PLHIV (89% on antiretroviral therapy), 321 (39%) had a positive symptom screen. In multivariate analysis, an unscheduled clinic visit (aOR 3.78, 95%CI 2.69-5.32), CD4 count <100 cells/μl (aOR 2.62, 95%CI 1.23-5.59) and previous history of TB (aOR 1.62, 95%CI 1.12-2.31) were predictors of a positive symptom screen. Among those with a positive symptom screen, 6% had active pulmonary TB. Smear microscopy sensitivity for TB was poor (30%) compared to culture and Xpert.
  
  
  CONCLUSIONS
  A positive symptom screen was common among PLHIV, creating a substantial laboratory burden. Smear microscopy had poor sensitivity for active TB disease. Given the high rate of positive symptom screen, substantial additional resources are needed to implement intensified TB case finding among PLHIV in high-burden areas.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Adelman
authors.affiliation: All Africa Leprosy Rehabilitation and Training Center Hospital, Addis Ababa, Ethiopia.
authors.forename: M
authors.initials: M
authors.lastname: Tsegaye
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Kempker
authors.affiliation: Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia.
authors.forename: T
authors.initials: T
authors.lastname: Alebachew
authors.affiliation: All Africa Leprosy Rehabilitation and Training Center Hospital, Addis Ababa, Ethiopia.
authors.forename: K
authors.initials: K
authors.lastname: Haile
authors.affiliation: Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Tesfaye
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Aseffa
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000328:Adult; D000465:Algorithms; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D015999:Multivariate Analysis; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology; D014944:World Health Organization