British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 4, Issue.: 29 (11-20 October)
Serial Clinical Screening for Active Tuberculosis among HIV-infected Kenyan Adults
Ellie R. Carmody1*, Aabid Ahmed2**, Robert S. Holzman3, Farhad Abdulaziz2, Musa Mwamzuka2, Maura Laverty1 and Sumathi Sivapalasingam1 1Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, USA.
2Bomu Medical Centre, Mombasa, Kenya.
3Department of Environmental Medicine and Biostatistics, New York University School of Medicine, New York, USA.
Ellie R. Carmody1*, Aabid Ahmed2**, Robert S. Holzman3, Farhad Abdulaziz2, Musa Mwamzuka2, Maura Laverty1 and Sumathi Sivapalasingam1
1Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, USA.
(1) E. Umit Bagriacik, Department of Immunology, Gazi University, Turkey.
(1) Koen Van Rompay, University of California, USA.
(2) Kristina Krohn, University of Minnesota, USA.
Complete Peer review History: http://www.sciencedomain.org/review-history/5084
Setting: Urban, non-governmental HIV outpatient clinic in Mombasa, Kenya.
Objective: To report outcomes and assess feasibility of serial clinical screening for active TB among adults enrolled in outpatient HIV care in a resource-limited setting.
Design: Longitudinal analysis of screening conducted during routine clinic visits of HIV-infected Kenyan adults. The provider-initiated screen included TB symptom assessment and targeted physical exam. Participants with >1 symptom/sign were to submit sputum for microscopy and undergo chest radiography.
Results: Over 33 months, 4,854 HIV-infected outpatients were serially screened for active TB at a median interval of 3 months. Treatment for active TB was started in 127 (2.6%). Of those 127, 77 (60.6%) were diagnosed based on first screen, and 50 (39.4%) were diagnosed thereafter. Among those 50 diagnosed upon subsequent screens, 28 (56%) were identified in association with positive screens, suggesting that 22% (28 of 127) of TB diagnoses could be attributed to the serial screening protocol.
Conclusion: Provider-initiated serial clinical screening during routine visits of HIV-infected outpatients continued to prompt treatment of active TB beyond initial screening. Serial screening strategies may lead to earlier TB treatment in patients receiving ongoing HIV care in resource-limited settings.
Africa; intensified case finding; epidemiology.
Full Article - PDF Page 4791-4801
DOI : 10.9734/BJMMR/2014/6647Review History Comments