HIV Infection Does Not Affect Active Case Finding of Tuberculosis in South African Gold Miners

Abstract

Rationale: Gold miners in South Africa undergo annual radiological screening for tuberculosis in an occupational health center of a gold mining company, but the optimal screening algorithm is unclear. Objectives: To evaluate methods for active case detection of tuberculosis. Methods: A sequential sample of miners attending annual medical examination was screened for tuberculosis using a symptom questionnaire, chest radiograph, and two sputum specimens for microscopy and culture. Measurements and Main Results: There were 1,955 miners included in this study; all were male with a median age of 41 years (range, 20-61 yr). Presence of at least one of a trio of symptoms (new or worsening cough, night sweats, or weight loss) had similar sensitivity (29.4%) to either chest radiograph (25.5%) or sputum smear (25.5%). These sensitivities did not differ by HIV status. Presence of one or more elements of the symptom trio and/or new radiological abnormality substantially increased sensitivity to 49.0%. Specificity of the symptom trio was higher in HIV-uninfected (91.8%) than in HIV-infected persons (88.2%; P 5 0.018). Specificity of chest radiography and smear were similar (98.7% and 99.0%, respectively) and did not differ by HIV status (both P values . 0.8).Conclusions: In a population of gold miners who undergo regular radiological screening, the addition of chest radiography to symptom screening substantially improved the sensitivity and positive predictive value. HIV infection did not alter the sensitivity of the screening tool.

Tuberculosis preventive therapy: An underutilised strategy to reduce individual risk of TB and contribute to TB control

“…[18] Chest radiography combined with symptom screening increased the sensitivity of TB screening, particularly among SA goldminers. [18][19][20] On the basis of these results, the WHO recommends that TB disease among people living with HIV be excluded before starting IPT, using a symptom screen of current cough, night sweats, fever and weight loss. [21] In HIV clinics that routinely screen their patients at every clinic visit, the WHO TB symptom screen performs less well, particularly among patients on ART.…”

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

“…8 Radiography in miners has much lower sensitivity for culture-confirmed TB (~25%) than screening-naïve populations (>90%), potentially reflecting 'screening escape'. 89 CXR screening is highly efficient, and should be investigated in very high transmission settings, for example, combined with other intensified TB-HIV activities in South African townships where the adult prevalence of culture-positive TB is up to 4% (NNTS ~25), and for outreach screening in prisons. Another obvious application would be in facility-based screening (Figure 1).…”

Provider-initiated sympton screening for tuberculosis in Zimbabwe: diagnostic value and the effect of HIV status

“…Symptom screening is often the only practical approach but, at least in HIV-negative (HIV−) individuals, TB symptom screening is considerably less sensitive when used for provider-initiated TB screening than when applied to patients who have self-presented for the investigation of ill health. [9][10][11][12][13][14][15] Evidence is mounting that this may also be true for HIV-positive (HIV+) individuals. [5][6][7][8][12][13][14][15][16] Screening failure can have major adverse consequences.…”

“…[9][10][11][12][13][14][15] Evidence is mounting that this may also be true for HIV-positive (HIV+) individuals. [5][6][7][8][12][13][14][15][16] Screening failure can have major adverse consequences. In patients starting antiretroviral therapy, undiagnosed TB is common and carries a substantially increased risk of death or hospitalization in the first few months of treatment.…”