Active Tuberculosis Case-Finding Among Pregnant Women Presenting to Antenatal Clinics in Soweto, South Africa

Abstract

Background Human immunodeficiency virus (HIV) and tuberculosis (TB) are among the leading causes of death among women of reproductive age worldwide. TB is a significant cause of maternal morbidity. Detection of TB during pregnancy could provide substantial benefits to women and their offspring. Methods This was a cross-sectional implementation research study of integrating active TB case-finding with delivery of antenatal and prevention of mother-to-child transmission (PMTCT) services in six clinics in Soweto, South Africa. All pregnant women ≥18 years of age presenting for routine care to these public clinics were screened for symptoms of active TB, cough ≥2 weeks, sputum production, fevers, night sweats or weight loss, regardless of their HIV status. Participants with any symptom of active TB were asked to provide a sputum specimen for smear microscopy, mycobacterial culture and drug-susceptibility testing. Results Between December 2008 and July 2009, 3,963 pregnant women were enrolled and screened for TB, of whom 1,454 (36.7%) were HIV-seropositive. Any symptom of TB was reported by 23.1% of HIV-seropositive and 13.8% of HIV-seronegative women (p<0.01). Active pulmonary TB was diagnosed in 10/1,454 HIV-seropositve women (688 per 100,000) and 5/2,483 HIV-seronegative women (201 per 100,000, p = 0.03). The median CD4+ T-cell count among HIV-seropositive women with TB was similar to that of HIV-seropositive women without TB (352 versus 333 cells/μL, p=0.85). Conclusions There is a high burden of active TB among HIV-seropositive pregnant women. TB screening and provision of isoniazid preventive therapy and antiretroviral therapy should be integrated with PMTCT services.

Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya

“…Half as many pregnant women reported TB symptoms at enrollment in HIV care as other PLHIV; if TB diagnostic testing were limited to pregnant women reporting symptoms in the WHO algorithm, more than two-thirds of laboratory-confirmed pulmonary TB would have been missed. These findings are consistent with data from other studies of TB screening among pregnant women living with HIV [11, 25–28]. One possible explanation for this difference is that pregnancy “masks” the symptoms of TB, making common TB symptoms such as weight loss less evident [29].…”

Tuberculosis prevention in HIV-infected pregnant women in South Africa

“…16 HIVinfected adults may also have a high prevalence of subclinical TB disease, 17 with HIV-infected pregnant women also less likely to be sputum acid-fast bacilli smear-positive than HIVuninfected pregnant women with TB disease. 7,18 Barriers to accessing care may contribute further to the under-diagnosis of TB in these women.…”

Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care

“…Childhood tuberculosis was additionally very common (35%), reflecting the devastating effect of the adult HIV/TB co-epidemics on children (Hesseling et al, 2009). TB screening during pregnancy, potentially leading to reduced infant TB-exposure through maternal disease identification, was not done in majority of mothers (72%), which requires intervention (Gounder et al, 2011).…”