Intensive screening for tuberculosis among people newly diagnosed with HIV in rural Cameroon

E Mbu, Melissa Sander, F Sauter, A. Zoufaly, Mark Bronsvoort, Kenton L. Morgan, J Noeske, J-L Abena Foe

Research output: Contribution to conferencePoster

Abstract

Background: Bacteriological confirmation of TB in people living with HIV is hampered by generally lower rates of diagnostic test sensitivity than in those without HIV infection. In settings with high rates of HIV and TB co-infection, it is important to assess TB prevalence and determine the diagnostic sensitivity of available laboratory methods to help guide clinician and program approaches to the diagnosis of TB.
Design/Methods: Adults newly diagnosed with HIV at a hospital in Northwest Cameroon were systematically tested for TB regardless of symptoms. All those who elected to participate received free CD4 testing and TB testing by smear microscopy and culture on liquid (MGIT) and solid (LJ) media.
Results: Among 1,149 people screened, 940 produced sputum for TB culture and microscopy. The prevalence of culture-positive TB was 13.6% (95% CI, 11.9-16.3%). Of those tested for TB, 68% were women, the median age was 35 years (IQR, 28-42 years), the median CD4 count was 291cells/mL (IQR, 116-496cells/mL), and 86% had a positive WHO symptom screen including one or more of current cough, fever, night sweats and weight loss.
The sensitivity of direct smear microscopy in this population was 24.4% (95% CI, 17.9-32.4%) vs. culture. In comparison to those with smear-negative TB, patients with smear-positive TB had lower CD4 cell counts, more symptoms of TB and were more likely to have WHO stage 3 or 4 (AIDS) disease. However, while those with smear-positive TB had more advanced disease, those with smear-negative TB had a significantly longer delay to start treatment (26 days vs. 2 days) and poorer outcomes, with both higher rates of initial loss to follow-up and greater likelihood of death.
Conclusions: These findings highlight the need for better diagnostics and close patient follow-up to facilitate faster detection of TB cases and improve patient outcomes, particularly among people living with HIV who have smear-negative TB.
Original languageEnglish
Publication statusPublished - 2016
Event47th Union World Conference on Lung Health - Liverpool, United Kingdom
Duration: 26 Oct 201629 Oct 2016

Conference

Conference47th Union World Conference on Lung Health
Country/TerritoryUnited Kingdom
CityLiverpool
Period26/10/1629/10/16

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