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PLoS One. 2013 Oct 17;8(10):e77697. doi: 10.1371/journal.pone.0077697. eCollection 2013.

Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening.

Author information

1
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland ; Swiss Tropical and Public Health Institute, Basel, Switzerland ; University of Basel, Basel, Switzerland.

Abstract

OBJECTIVES:

In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries.

METHODS AND FINDINGS:

We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (pā€Š=ā€Š0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (pā€Š=ā€Š0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%).

CONCLUSIONS:

Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.

PMID:
24147059
PMCID:
PMC3798412
DOI:
10.1371/journal.pone.0077697
[Indexed for MEDLINE]
Free PMC Article

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