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

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

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 (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Africa South of the Sahara / epidemiology
  • Anti-Retroviral Agents / therapeutic use
  • Asia / epidemiology
  • Female
  • Geography
  • Humans
  • Latin America / epidemiology
  • Male
  • Surveys and Questionnaires
  • Tuberculosis / diagnosis*
  • Tuberculosis / drug therapy*
  • Tuberculosis / epidemiology

Substances

  • Anti-Retroviral Agents