title: High prevalence of tuberculosis in newly enrolled HIV patients in Zambia: need for enhanced screening approach.
abstract: Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. In Zambia, smear microscopy and chest radiography (CXR) are the primary TB diagnostic tools, and most cases are not bacteriologically confirmed.
  
  
  
  We implemented enhanced screening to determine the TB burden among new human immunodeficiency virus (HIV) clinic enrollees.
  
  
  
  Consecutive adult HIV clinic enrollees were screened, regardless of symptoms. All underwent microscopy (Ziehl-Neelsen/fluorescence microscopy) on three sputum specimens, physical examination, and digital CXR. Sputum, blood and urine specimens were cultured. Xpert(®) MTB/RIF testing was performed retrospectively.
  
  
  
  From July 2011 to April 2012, 399 patients were enrolled. The median age was 34.4 years; body mass index was 20.8 kg/m(2), CD4 count was 202 cells/μl and 86% were symptomatic. Culture-confirmed TB was diagnosed in 72/399 (18%) patients; an additional 31/399 (8%) were culture-negative but diagnosed clinically. Symptom screening for any cough, fever, weight loss or night sweats had high sensitivity (95%) but low specificity (14%) for detecting culture-confirmed cases. Among culture-confirmed cases, 35/72 (49%) were missed clinically and detected only by culture. Xpert was 64% sensitive and 98% specific.
  
  
  
  High TB prevalence was found in Zambians newly enrolled into HIV care. Screening with sensitive diagnostics should be considered with culture when feasible in this population.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: G
authors.initials: G
authors.lastname: Henostroza
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: J B
authors.initials: JB
authors.lastname: Harris
authors.affiliation: Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: R
authors.initials: R
authors.lastname: Chitambi
authors.affiliation: Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: M
authors.initials: M
authors.lastname: Siyambango
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: E R
authors.initials: ER
authors.lastname: Turnbull
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: K R
authors.initials: KR
authors.lastname: Maggard
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: A
authors.initials: A
authors.lastname: Krüüner
authors.affiliation: National Tuberculosis and Leprosy Control Programme, Ministry of Health of Zambia, Lusaka, Zambia.
authors.forename: N
authors.initials: N
authors.lastname: Kapata
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: S E
authors.initials: SE
authors.lastname: Reid
mesh_terms: D000328:Adult; D001431:Bacteriological Techniques; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D015995:Prevalence; D013902:Radiography, Thoracic; D015203:Reproducibility of Results; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D015024:Zambia / Q000453:epidemiology