Low BMI and HIV infection were the most robust predictors of TB in our inmates; chest pain was additionally retained in one model. BMI and HIV should be further evaluated as the basis for TB screening rules for inmates, with modification as needed to improve the performance of the rules.
Background: According to WHO, CDC, IDSA and ATS guidelines, patients with pulmonary tuberculosis (Tb) can be considered as non infectious when: 1) they are receiving multiple drugs for 2 to 3 weeks; 2) there is an improvement in clinical condition; 3) the likelihood of MDR-Tb is very small. Objective: To determine the time for sputum reversion since the start of anti-Tb treatment in prisoners from four jails in Medellin and Bucaramanga, Colombia between May 2010 to April 2011.Methods: Prospective cohort study. All prisoners diagnosed with Tb by sputum smear or culture were followed for two years: monthly for the first six months after the start of treatment, bimonthly the next six months, and quarterly the second year. During follow-up, we took two spontaneous and one induced sputum samples for auramine-rodhamine stain, and cultures in thin layer agar, Löwestein-Jensen and MGIT for the both first samples. We did time to event analysis.Results: We could follow 45 of 47 positive patients (one was transferred to another jail and one Tb-related death). The median for sputum smear reversion was 33 days (IQR: 31-60), and for culture was 55 days (IQR: 32-68). 90% of the patients had sputum smear and culture negative at 102 days. The time for sputum to become negative by culture had a positive correlation with the sputum grade at the moment of diagnosis: negative smear with positive culture= median 31.5 days, smear with 1+ = 58.5 days, smear 2+ = 62 days, and smear 3+ = 65 days (p value = 0.007).
Conclusion:After starting treatment the reversion of cultures took two or more months in ≥50% cases. That is forcing us to rethink the recommendations about the isolation of patients with pulmonary Tb in prisons, and suggests the need to use mycobacterial cultures on sputum to follow-up those patients.
Setting: Peri-urban health facilities providing HIV and TB care in Zambia.Objective: To evaluate 1) the impact of Xpert® MTB/RIF on time-to-diagnosis, treatment initiation, and outcomes among adult people living with HIV (PLHIV) on antiretroviral therapy
(ART); and 2) the diagnostic performance of Xpert and Determine™ TB-LAM Ag assays.Design: Quasi-experimental study design with the first cohort evaluated per standard-of-care (SOC; first sputum tested using smear microscopy) and the second cohort per an algorithm using Xpert
as initial test (intervention phase; IP). Xpert testing was provided onsite in Chongwe District, while samples were transported 5–10 km in Kafue District. TB was confirmed using mycobacterial culture.Results: Among 1350 PLHIV enrolled, 156 (15.4%) had confirmed TB. Time from
TB evaluation to diagnosis (P = 0.018), and from evaluation to treatment initiation (P = 0.03) was significantly shorter for IP than for SOC. There was no difference in all-cause mortality (7.0% vs. 8.6%). TB-LAM Ag showed higher sensitivity with lower CD4 cell count: 81.8% at
CD4 < 50 cells/mm3 vs. 31.7% overall.Conclusion: Xpert improved time to diagnosis and treatment initiation, but there was no difference in all-cause mortality. High sensitivity of Determine TB-LAM Ag at lower CD4 count supports increased use in settings providing care
to PLHIV, particularly with advanced HIV disease.
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