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High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening

BACKGROUND: Tuberculosis is a major health concern in prisons, particularly where HIV prevalence is high. Our objective was to determine the undiagnosed pulmonary tuberculosis (“undiagnosed tuberculosis”) prevalence in a representative sample of prisoners in a South African prison. In addition we in...

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Autores principales: Telisinghe, Lilanganee, Fielding, Katherine L., Malden, Justin L., Hanifa, Yasmeen, Churchyard, Gavin J., Grant, Alison D., Charalambous, Salome
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907552/
https://www.ncbi.nlm.nih.gov/pubmed/24498059
http://dx.doi.org/10.1371/journal.pone.0087262
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author Telisinghe, Lilanganee
Fielding, Katherine L.
Malden, Justin L.
Hanifa, Yasmeen
Churchyard, Gavin J.
Grant, Alison D.
Charalambous, Salome
author_facet Telisinghe, Lilanganee
Fielding, Katherine L.
Malden, Justin L.
Hanifa, Yasmeen
Churchyard, Gavin J.
Grant, Alison D.
Charalambous, Salome
author_sort Telisinghe, Lilanganee
collection PubMed
description BACKGROUND: Tuberculosis is a major health concern in prisons, particularly where HIV prevalence is high. Our objective was to determine the undiagnosed pulmonary tuberculosis (“undiagnosed tuberculosis”) prevalence in a representative sample of prisoners in a South African prison. In addition we investigated risk factors for undiagnosed tuberculosis, to explore if screening strategies could be targeted to high risk groups, and, the performance of screening tools for tuberculosis. METHODS AND FINDINGS: In this cross-sectional survey, male prisoners were screened for tuberculosis using symptoms, chest radiograph (CXR) and two spot sputum specimens for microscopy and culture. Anonymised HIV antibody testing was performed on urine specimens. The sensitivity, specificity and predictive values of symptoms and investigations were calculated, using Mycobacterium tuberculosis isolated on sputum culture as the gold standard. From September 2009 to October 2010, 1046 male prisoners were offered enrolment to the study. A total of 981 (93.8%) consented (median age was 32 years; interquartile range [IQR] 27–37 years) and were screened for tuberculosis. Among 968 not taking tuberculosis treatment and with sputum culture results, 34 (3.5%; 95% confidence interval [CI] 2.4–4.9%) were culture positive for Mycobacterium tuberculosis. HIV prevalence was 25.3% (242/957; 95% CI 22.6–28.2%). Positive HIV status (adjusted odds ratio [aOR] 2.0; 95% CI 1.0–4.2) and being an ex-smoker (aOR 2.6; 95% CI 1.2–5.9) were independently associated with undiagnosed tuberculosis. Compared to the gold standard of positive sputum culture, cough of any duration had a sensitivity of 35.3% and specificity of 79.6%. CXR was the most sensitive single screening modality (sensitivity 70.6%, specificity 92.2%). Adding CXR to cough of any duration gave a tool with sensitivity of 79.4% and specificity of 73.8%. CONCLUSIONS: Undiagnosed tuberculosis and HIV prevalence was high in this prison, justifying routine screening for tuberculosis at entry into the prison, and intensified case finding among existing prisoners.
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spelling pubmed-39075522014-02-04 High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening Telisinghe, Lilanganee Fielding, Katherine L. Malden, Justin L. Hanifa, Yasmeen Churchyard, Gavin J. Grant, Alison D. Charalambous, Salome PLoS One Research Article BACKGROUND: Tuberculosis is a major health concern in prisons, particularly where HIV prevalence is high. Our objective was to determine the undiagnosed pulmonary tuberculosis (“undiagnosed tuberculosis”) prevalence in a representative sample of prisoners in a South African prison. In addition we investigated risk factors for undiagnosed tuberculosis, to explore if screening strategies could be targeted to high risk groups, and, the performance of screening tools for tuberculosis. METHODS AND FINDINGS: In this cross-sectional survey, male prisoners were screened for tuberculosis using symptoms, chest radiograph (CXR) and two spot sputum specimens for microscopy and culture. Anonymised HIV antibody testing was performed on urine specimens. The sensitivity, specificity and predictive values of symptoms and investigations were calculated, using Mycobacterium tuberculosis isolated on sputum culture as the gold standard. From September 2009 to October 2010, 1046 male prisoners were offered enrolment to the study. A total of 981 (93.8%) consented (median age was 32 years; interquartile range [IQR] 27–37 years) and were screened for tuberculosis. Among 968 not taking tuberculosis treatment and with sputum culture results, 34 (3.5%; 95% confidence interval [CI] 2.4–4.9%) were culture positive for Mycobacterium tuberculosis. HIV prevalence was 25.3% (242/957; 95% CI 22.6–28.2%). Positive HIV status (adjusted odds ratio [aOR] 2.0; 95% CI 1.0–4.2) and being an ex-smoker (aOR 2.6; 95% CI 1.2–5.9) were independently associated with undiagnosed tuberculosis. Compared to the gold standard of positive sputum culture, cough of any duration had a sensitivity of 35.3% and specificity of 79.6%. CXR was the most sensitive single screening modality (sensitivity 70.6%, specificity 92.2%). Adding CXR to cough of any duration gave a tool with sensitivity of 79.4% and specificity of 73.8%. CONCLUSIONS: Undiagnosed tuberculosis and HIV prevalence was high in this prison, justifying routine screening for tuberculosis at entry into the prison, and intensified case finding among existing prisoners. Public Library of Science 2014-01-30 /pmc/articles/PMC3907552/ /pubmed/24498059 http://dx.doi.org/10.1371/journal.pone.0087262 Text en © 2014 Telisinghe et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Telisinghe, Lilanganee
Fielding, Katherine L.
Malden, Justin L.
Hanifa, Yasmeen
Churchyard, Gavin J.
Grant, Alison D.
Charalambous, Salome
High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening
title High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening
title_full High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening
title_fullStr High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening
title_full_unstemmed High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening
title_short High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening
title_sort high tuberculosis prevalence in a south african prison: the need for routine tuberculosis screening
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907552/
https://www.ncbi.nlm.nih.gov/pubmed/24498059
http://dx.doi.org/10.1371/journal.pone.0087262
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