PMID- 28771504
OWN - NLM
STAT- MEDLINE
DCOM- 20170828
LR  - 20180504
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 8
DP  - 2017
TI  - A clinical scoring system to prioritise investigation for tuberculosis among
      adults attending HIV clinics in South Africa.
PG  - e0181519
LID - 10.1371/journal.pone.0181519 [doi]
AB  - BACKGROUND: The World Health Organization (WHO) recommendation for regular
      tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the
      first diagnostic test has major resource implications. OBJECTIVE: To develop a
      diagnostic prediction model for TB, for symptomatic adults attending for routine 
      HIV care, to prioritise TB investigation. DESIGN: Cohort study exploring a TB
      testing algorithm. SETTING: HIV clinics, South Africa. PARTICIPANTS:
      Representative sample of adult HIV clinic attendees; data from participants
      reporting >/=1 symptom on the WHO screening tool were split 50:50 to derive, then
      internally validate, a prediction model. OUTCOME: TB, defined as "confirmed" if
      Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and
      "clinical" if TB treatment started without microbiological confirmation, within
      six months of enrolment. RESULTS: Overall, 79/2602 (3.0%) participants on ART
      fulfilled TB case definitions, compared to 65/906 (7.2%) pre-ART. Among 1133/3508
      (32.3%) participants screening positive on the WHO tool, 1048 met inclusion
      criteria for this analysis: 52/515 (10.1%) in the derivation and 58/533 (10.9%)
      in the validation dataset had TB. Our final model comprised ART status (on ART > 
      3 months vs. pre-ART or ART < 3 months); body mass index (continuous); CD4
      (continuous); number of WHO symptoms (1 vs. >1 symptom). We converted this to a
      clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score
      of >/=3 identified those with TB with sensitivity and specificity of 91.8% and
      34.3% respectively. If investigation was prioritised for individuals with score
      of >/=3, 68% (717/1048) symptomatic individuals would be tested, among whom the
      prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be
      avoided, but 3% (9/331) with TB would be missed amongst those not tested.
      CONCLUSION: Our clinical score may help prioritise TB investigation among
      symptomatic individuals.
FAU - Hanifa, Yasmeen
AU  - Hanifa Y
AD  - London School of Hygiene & Tropical Medicine, London, United Kingdom.
FAU - Fielding, Katherine L
AU  - Fielding KL
AD  - London School of Hygiene & Tropical Medicine, London, United Kingdom.
FAU - Chihota, Violet N
AU  - Chihota VN
AD  - The Aurum Institute, Johannesburg, South Africa.
AD  - School of Public Health, Faculty of Health Sciences, University of the
      Witwatersrand, Johannesburg, South Africa.
FAU - Adonis, Lungiswa
AU  - Adonis L
AD  - Mamelodi Hospital, Pretoria, South Africa.
FAU - Charalambous, Salome
AU  - Charalambous S
AD  - The Aurum Institute, Johannesburg, South Africa.
AD  - School of Public Health, Faculty of Health Sciences, University of the
      Witwatersrand, Johannesburg, South Africa.
FAU - Foster, Nicola
AU  - Foster N
AD  - Health Economics Unit, School of public health and family medicine, University of
      Cape Town, Cape Town, South Africa.
FAU - Karstaedt, Alan
AU  - Karstaedt A
AD  - Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South
      Africa.
AD  - University of the Witwatersrand, Johannesburg, South Africa.
FAU - McCarthy, Kerrigan
AU  - McCarthy K
AD  - The Aurum Institute, Johannesburg, South Africa.
FAU - Nicol, Mark P
AU  - Nicol MP
AD  - Division of Medical Microbiology, Faculty of Health Sciences, University of Cape 
      Town, Cape Town, South Africa.
AD  - National Health Laboratory Service, Johannesburg, South Africa.
FAU - Ndlovu, Nontobeko T
AU  - Ndlovu NT
AD  - The Aurum Institute, Johannesburg, South Africa.
FAU - Sinanovic, Edina
AU  - Sinanovic E
AD  - Health Economics Unit, School of public health and family medicine, University of
      Cape Town, Cape Town, South Africa.
FAU - Sahid, Faieza
AU  - Sahid F
AD  - Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South
      Africa.
AD  - University of the Witwatersrand, Johannesburg, South Africa.
FAU - Stevens, Wendy
AU  - Stevens W
AD  - National Health Laboratory Service, Johannesburg, South Africa.
AD  - Department of Molecular Medicine and Haematology, School of Pathology, Faculty of
      Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
FAU - Vassall, Anna
AU  - Vassall A
AD  - London School of Hygiene & Tropical Medicine, London, United Kingdom.
FAU - Churchyard, Gavin J
AU  - Churchyard GJ
AD  - London School of Hygiene & Tropical Medicine, London, United Kingdom.
AD  - The Aurum Institute, Johannesburg, South Africa.
AD  - School of Public Health, Faculty of Health Sciences, University of the
      Witwatersrand, Johannesburg, South Africa.
AD  - Advancing Treatment and Care for TB/HIV, South African Medical Research Council
      Collaborating Centre for HIV and TB, Johannesburg, South Africa.
FAU - Grant, Alison D
AU  - Grant AD
AUID- ORCID: http://orcid.org/0000-0002-2437-5195
AD  - London School of Hygiene & Tropical Medicine, London, United Kingdom.
AD  - School of Public Health, Faculty of Health Sciences, University of the
      Witwatersrand, Johannesburg, South Africa.
AD  - School of Nursing and Public Health, Africa Health Research Institute, University
      of KwaZulu-Natal, Durban, South Africa.
LA  - eng
GR  - MR/K012126/1/Medical Research Council/United Kingdom
PT  - Journal Article
DEP - 20170803
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adult
MH  - *Ambulatory Care Facilities
MH  - Female
MH  - HIV Infections/*complications
MH  - Health Personnel
MH  - Humans
MH  - Male
MH  - Mass Screening/*methods
MH  - South Africa/epidemiology
MH  - Tuberculosis/*complications/*diagnosis/epidemiology
PMC - PMC5542442
EDAT- 2017/08/05 06:00
MHDA- 2017/08/29 06:00
CRDT- 2017/08/04 06:00
PHST- 2016/08/18 00:00 [received]
PHST- 2017/06/21 00:00 [accepted]
PHST- 2017/08/04 06:00 [entrez]
PHST- 2017/08/05 06:00 [pubmed]
PHST- 2017/08/29 06:00 [medline]
AID - 10.1371/journal.pone.0181519 [doi]
AID - PONE-D-16-33094 [pii]
PST - epublish
SO  - PLoS One. 2017 Aug 3;12(8):e0181519. doi: 10.1371/journal.pone.0181519.
      eCollection 2017.