Effectiveness of symptom screening and incidence of tuberculosis among adults and children living with HIV infection in India.
WHO recommends the use of a simplified symptom-based algorithm for screening for tuberculosis (TB) among people living with HIV (PLHIV). We assessed the feasibility and effectiveness of this algorithm and determined the prevalence and incidence of TB among PLHIV attending antiretroviral treatment (ART) centres in India.



We did a prospective multicentric implementation research study in four states of India. To rule out TB, we administered the WHO symptom-screen algorithm to all PLHIV every month for 6 months. If they were found to be symptomatic any time during this period, they were referred for investigations for TB. A case of TB diagnosed during the first month of screening was taken as a prevalent case while those detected TB in the subsequent 5 months were considered cases of incident TB. We calculated the incidence rate using the person-years method. Results . Between May 2012 and October 2013, a total of 6099 adults and 1662 children living with HIV were screened for TB at the ART centres of four states. Of the 6099 adult PLHIV, 1815 (30%) had at least one symptom suggestive of TB, of whom only 634 (35%) were referred for investigations of TB. Of those referred, 97 (15%) PLHIV were diagnosed with TB. Overall, the prevalence of undiagnosed TB was 0.84 person-years and in the subsequent period, the incidence of TB was 2.4/100 person-years (95% CI 1.90-3.10). Among 1662 children, 434 (26%) had at least one symptom suggestive of TB. But only 57 (13%) children were referred for investigations of TB and 13 (23%) of them were diagnosed with TB. The prevalence of TB among children was 0.5% and its incidence among them was 2.7/100 person-years (95% CI 1.60-4.30).



Prevalence and incidence of TB is high among PLHIV attending ART centres. This emphasizes the need to strengthen regular screening for symptoms of TB and further referral of those symptomatic for diagnosis of TB.
National Institute for Research in Tuberculosis, No. 1, Sathiyamoorthy Road, Chetput, Chennai 600031, Tamil Nadu, India.
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Padmapriyadarsini
National Institute for Research in Tuberculosis, No. 1, Sathiyamoorthy Road, Chetput, Chennai 600031, Tamil Nadu, India.
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Bhavani
National Institute for Research in Tuberculosis, No. 1, Sathiyamoorthy Road, Chetput, Chennai 600031, Tamil Nadu, India.
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Sekar
Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, India.
Government Rajaji Medical College and Hospital, Madurai, Tamil Nadu, India.
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Selvaraj
National Institute for Research in Tuberculosis, No. 1, Sathiyamoorthy Road, Chetput, Chennai 600031, Tamil Nadu, India.
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Poornagangadevi
Ashakirana Hospital, Mysore, Karnataka, India.
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Mothi
Government Kilpauk Medical College and Hospital, Kilpauk, Tamil Nadu, India.
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Nandagopal
Government Headquarters Hospital, Krishnagiri, Tamil Nadu, India.
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Vennila
Niloufer Hospital, Hyderabad, Telengana, India.
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Priyadarshini
Government District Hospital, Tiruvallur, Tamil Nadu, India.
Mahesh
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Manisha
Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India.
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Sanjeeva
National Institutes of Tuberculosis and Lung Diseases, New Delhi, India.
Upasna
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Agarwal
Institute of Child Health and Children's Hospital, Chennai, Tamil Nadu, India.
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Suresh
National AIDS Control Organization, New Delhi, India.
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Rewari
National Institute for Research in Tuberculosis, No. 1, Sathiyamoorthy Road, Chetput, Chennai 600031, Tamil Nadu, India.
Soumya
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Swaminathan
D000293:Adolescent; D000328:Adult; D002648:Child; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology