Tuberculosis Screening Practices in HIV-Infected Adult Patients Enrollong at the Kalingalinga Anti-Retroviral Therapy(ART) Clinic in Lusaka

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Sally, Trollip J.
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Tuberculosis (TB) screening practices in human immunodeficiency virus (HIV)infected adult patients enrolling at the Kalingalinga anti- retroviral therapy (ART) clinic in Lusaka, Zambia. Background: There are currently no studies describing TB screening practices in HIV infected adult patients enrolling at various ART clinics in Lusaka. Such data are critically needed to guide national health policy in areas of TB screening in HIV infected patients as TB is the most common cause of morbidity and mortality in HIV infected patients.In this descriptive longitudinal study, TB screening practices in HIV-infected adults at the Kalingalinga ART clinic were assessed by file reviews, parallel TB screening of patients by study staff and by interviews with the ART clinic clinicians.Basic demographic, medical, laboratory and radiological data were obtained to determine factors associated with TB screening.From May to December 2009, we enrolled 154 consecutive patients eligible for TB screening; in addition 15 patients underwent parallel screening by study staff and 3 ART clinic clinicians were interviewed on their TB screening practices. The median age was 34 years with an inter-quartile range of 29-40, 79 (51%) were female. The CD4 count was below 200cells/μl in 72% of the patients while 72% of the patients were either WHO stage III or IV. The median Body Mass Index (BMI) was 19 with an inter-quartile range of 17 to 21. The TB screening form was only used in 39%. Eighty-nine percent had TB symptoms for > 2 weeks. Eighty-four percent presented with a cough plus other symptoms suggestive of TB. Sputum AAFB (acid alcohol fast bacilli) examination was ordered in 42% (65) of patients but only 30% (47) were performed. A CXR was ordered in 38% (58) of patients but only 22% of the 58 (13) were performed, 92% of the total sample did not have a chest x-ray (CXR) done. Out of the 154 patients, 66% (102) were not screened for TB as neither sputum for AAFB nor a CXR was ordered/performed. Fifty-one patients (33%) were diagnosed with TB as follows: sputum positive 15, sputum negative 27, EPTB 5, disseminated TB 1 and PTB without specification of type, 3.TB screening practices at the Kalingalinga ART clinic are inadequate mainly due to increased workload for the few clinicians, erratic availability of sputum AAFB examination facilities and inability of patients to do chest x-rays due to financial constraints. Policies to improve on workforce in ART clinics, improvement in supply of sputum AAFB examination facilities and reduction in cost of performing x-rays should be considered in this population, given the proven efficacy of anti-tuberculous therapy especially when TB is diagnosed early and this will also lead to reduction in continued spread of TB in the community.
Tuberculosis Screening , Tuberculosis Screening in HIV-Infected Adults