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

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

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..

Publication types

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

MeSH terms

  • Africa South of the Sahara
  • Americas
  • Anti-HIV Agents / economics*
  • Anti-HIV Agents / therapeutic use*
  • Asia
  • Child
  • Child, Preschool
  • Developing Countries
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / economics
  • Humans
  • Infant
  • Microscopy / economics
  • Microscopy / methods
  • Mycobacterium tuberculosis / isolation & purification
  • Poverty
  • Radiography, Thoracic / economics
  • Radiography, Thoracic / methods
  • Sputum / microbiology
  • Tuberculosis / complications
  • Tuberculosis / diagnosis*
  • Tuberculosis / drug therapy
  • Tuberculosis / economics*

Substances

  • Anti-HIV Agents