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Author Notes:

David Horne, 325 9th Ave., Box 359762, Seattle, WA 98104; Email: dhorne@uw.edu; (206) 372-4372 (phone), (206) 744-8584 (fax)

We thank the staff at the Ahero Sub-district Hospital and Bondo District Hospital antenatal clinics, KEMRI/CDC laboratory personnel, as well as our study staff and participants.

The authors report no conflicts of interest.

Subject:

Research Funding:

SOURCE OF FUNDING: This work was supported by the National Institute of Allergy and Infectious Diseases and the National Institute of Child Health and Human Development at the National Institutes of Health [grant number K23 AI 85036-01 to DJH, K24 HD054314-06 to GJS, K12 HD000850 to LMC, T32 AI07140 to SML], the National Center for Research Resources at the National Institutes of Health [grant number UL1TR000423] and the Firland Foundation.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • tuberculosis
  • HIV
  • pregnancy
  • Xpert
  • urine TB LAM
  • screening
  • SOUTH-AFRICA
  • ACTIVE TUBERCULOSIS
  • PULMONARY TUBERCULOSIS
  • ANTIRETROVIRAL THERAPY
  • POSTPARTUM WOMEN
  • CHILD HEALTH
  • PREVENTION
  • RISK
  • INDIVIDUALS
  • ACCURACY

Tuberculosis Case Finding in HIV-Infected Pregnant Women in Kenya Reveals Poor Performance of Symptom Screening and Rapid Diagnostic Tests

Tools:

Journal Title:

Journal of Acquired Immune Deficiency Syndromes

Volume:

Volume 71, Number 2

Publisher:

, Pages 219-227

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: Tuberculosis (TB) during pregnancy in HIV-infected women is associated with poor maternal and infant outcomes. There are limited data on TB prevalence, optimal TB screening, and performance of rapid diagnostics in pregnant HIV-infected women. Methods: We conducted a cross-sectional study among HIV-infected pregnant women seeking antenatal care in western Kenya. After a standardized questionnaire, sputum smear microscopy for acid-fast bacilli, mycobacterial liquid culture, GeneXpert MTB/RIF (Xpert), urine lipoarabinomannan, and tuberculin skin testing were performed. We determined prevalence and correlates of culture-confirmed pulmonary TB, and compared diagnostic performance of World Health Organization (WHO) symptom screening and rapid diagnostic tests to sputum culture. Results: Between July 2013 and July 2014, we enrolled 306 women. Among 288 women with a valid sputum culture result, 54% were on antiretroviral treatment, median CD4 cell count was 437 cell per cubic millimeter (IQR 342-565), and prevalence of culture-confirmed pulmonary TB was 2.4% (confidence interval: 1.0% to 4.9%). Cough >2 weeks (P 0.04) and positive tuberculin skin testing (≥5 mm, P 0.03) were associated with pulmonary TB. Women with TB were 23-fold (95% confidence interval: 4.4 to 116.6) more likely to report a household member with TB symptoms (P 0.002). WHO symptom screen (43%), acid-fast bacilli smear (0%), Xpert (43%), and lipoarabinomannan (0%) had low sensitivity but high specificity (81%, 99%, 99%, and 95%, respectively) for pulmonary TB. Conclusions: HIV-infected pregnant women had appreciable prevalence of pulmonary TB despite modest immunosuppression. Current TB screening and diagnostic tools perform poorly in pregnant HIV-infected women. Adapted TB screening tools that include household member TB symptoms may be useful in this population.

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