Dataset Information

A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.

ABSTRACT:

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.

SUBMITTER: Hanifa Y

PROVIDER: S-EPMC5542442 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.

Hanifa Yasmeen Y Fielding Katherine L KL Chihota Violet N VN Adonis Lungiswa L Charalambous Salome S Foster Nicola N Karstaedt Alan A McCarthy Kerrigan K Nicol Mark P MP Ndlovu Nontobeko T NT Sinanovic Edina E Sahid Faieza F Stevens Wendy W Vassall Anna A Churchyard Gavin J GJ Grant Alison D AD

PloS one 20170803 8

<h4>Background</h4>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.<h4>Objective</h4>To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation.<h4>Design</h4>Cohort study exploring a TB testing algorithm.<h4>Setting</h4>HIV clinics, South Africa.<h4>Participants</h4>Repre ...[more]

PMID: 28771504

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Dataset Information

A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.

Background

Objective

Design

Setting

Participants

Outcome

Results

Conclusion

Publications

A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.

Similar Datasets

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