Serial Clinical Screening for Active Tuberculosis among HIV-infected Kenyan Adults
Ellie R. Carmody *
Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, USA.
Aabid Ahmed *
Bomu Medical Centre, Mombasa, Kenya.
Robert S. Holzman
Department of Environmental Medicine and Biostatistics, New York University School of Medicine, New York, USA.
Farhad Abdulaziz
Bomu Medical Centre, Mombasa, Kenya.
Musa Mwamzuka
Bomu Medical Centre, Mombasa, Kenya.
Maura Laverty
Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, USA.
Sumathi Sivapalasingam
Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, USA.
*Author to whom correspondence should be addressed.
Abstract
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.
Keywords: Africa, intensified case finding, epidemiology.