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J Pediatric Infect Dis Soc. 2015 Mar;4(1):30-8. doi: 10.1093/jpids/piu020. Epub 2014 Mar 28.

Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices.

Author information

1
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.
2
University of Ghana Medical School, Korle Bu, Accra.
3
Women's Equity in Access to Care & Treatment, Kigali, Rwanda.
4
Inserm, U897, Epidémiologie-Biostatistiques ISPED, University of Bordeaux, France.
5
Department of Child Health and Pediatrics, Moi University School of Medicine, Kenya.
6
Indiana University School of Medicine.
7
University of Chile School of Medicine, Santiago.
8
Vanderbilt University School of Medicine, Nashville, Tennessee.
9
Tuberculosis Initiative, Texas Children's Hospital, and Baylor College of Medicine, Houston.
10
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
11
Sanglah Hospital, Udayana University, Bali, Indonesia.
12
Penang Hospital, Malaysia.
13
Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
14
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa.
15
Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Switzerland.

Abstract

BACKGROUND:

The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge.

METHODS:

We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study.

RESULTS:

Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children.

CONCLUSIONS:

Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected children.

KEYWORDS:

HIV; low-income countries; pediatric; survey; tuberculosis.

PMID:
26407355
PMCID:
PMC5654358
DOI:
10.1093/jpids/piu020
[Indexed for MEDLINE]
Free PMC Article

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