S Sawry1, H Moultrie1, A Van Rie2. 1. Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 2. Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
Abstract
SETTING: Out-patient paediatric human immunodeficiency virus (HIV) clinic in Soweto, South Africa. OBJECTIVE: To evaluate the yield of symptom screening for intensified tuberculosis (TB) case finding (ICF) and potential eligibility for isoniazid preventive therapy (IPT) in children living with HIV on antiretroviral treatment (ART). DESIGN: A cohort of 247 children (age 0-8 years) was systematically screened for TB symptoms during the first 2 years of ART. Children with symptoms were assessed using chest X-ray, smear microscopy and culture. RESULTS: Over 2 years, 1346 TB symptom screens were performed in 220 children not on anti-tuberculosis treatment. Only 48 (3.6%) screens in 39 children were positive for current cough, current fever, weight loss (>5%) or contact with a TB patient. The positive predictive value of symptom screening was 8.9% (95%CI 2.5-21.2); the sensitivity was 57.1% (95%CI 18.4-90.1). Most children (85.8%) were IPT-eligible according to World Health Organization guidelines; however, few (1.2%) were eligible according to South African guidelines. CONCLUSIONS: The yield of TB symptom screening was relatively poor in children on ART, highlighting the need for future research on paediatric TB symptom screening approaches in this population. The vastly different criteria for IPT eligibility between guidelines suggest that research is also needed to define the optimal use of IPT in children on ART.
SETTING: Out-patient paediatric human immunodeficiency virus (HIV) clinic in Soweto, South Africa. OBJECTIVE: To evaluate the yield of symptom screening for intensified tuberculosis (TB) case finding (ICF) and potential eligibility for isoniazid preventive therapy (IPT) in children living with HIV on antiretroviral treatment (ART). DESIGN: A cohort of 247 children (age 0-8 years) was systematically screened for TB symptoms during the first 2 years of ART. Children with symptoms were assessed using chest X-ray, smear microscopy and culture. RESULTS: Over 2 years, 1346 TB symptom screens were performed in 220 children not on anti-tuberculosis treatment. Only 48 (3.6%) screens in 39 children were positive for current cough, current fever, weight loss (>5%) or contact with a TB patient. The positive predictive value of symptom screening was 8.9% (95%CI 2.5-21.2); the sensitivity was 57.1% (95%CI 18.4-90.1). Most children (85.8%) were IPT-eligible according to World Health Organization guidelines; however, few (1.2%) were eligible according to South African guidelines. CONCLUSIONS: The yield of TB symptom screening was relatively poor in children on ART, highlighting the need for future research on paediatric TB symptom screening approaches in this population. The vastly different criteria for IPT eligibility between guidelines suggest that research is also needed to define the optimal use of IPT in children on ART.
Authors: Kenneth S Gunasekera; Bryan Vonasek; Jacquie Oliwa; Rina Triasih; Christina Lancioni; Stephen M Graham; James A Seddon; Ben J Marais Journal: Pathogens Date: 2022-03-23
Authors: Bryan Vonasek; Tara Ness; Yemisi Takwoingi; Alexander W Kay; Susanna S van Wyk; Lara Ouellette; Ben J Marais; Karen R Steingart; Anna M Mandalakas Journal: Cochrane Database Syst Rev Date: 2021-06-28
Authors: L H Chaisson; F Naufal; P Delgado-Barroso; H S Alvarez-Manzo; K O Robsky; C R Miller; J E Golub; A E Shapiro Journal: Int J Tuberc Lung Dis Date: 2021-06-01 Impact factor: 3.427