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Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding

BACKGROUND: The World Health Organization strongly recommends regular screening for tuberculosis (TB) in HIV-positive individuals. OBJECTIVE: To compare the outcome of anti-tuberculosis treatment (ATT) in HIV-positive adults diagnosed with TB through active case-finding (ACF) or passive case-finding...

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Autores principales: Balcha, Taye T., Skogmar, Sten, Sturegård, Erik, Björkman, Per, Winqvist, Niclas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Co-Action Publishing 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377322/
https://www.ncbi.nlm.nih.gov/pubmed/25819037
http://dx.doi.org/10.3402/gha.v8.27048
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author Balcha, Taye T.
Skogmar, Sten
Sturegård, Erik
Björkman, Per
Winqvist, Niclas
author_facet Balcha, Taye T.
Skogmar, Sten
Sturegård, Erik
Björkman, Per
Winqvist, Niclas
author_sort Balcha, Taye T.
collection PubMed
description BACKGROUND: The World Health Organization strongly recommends regular screening for tuberculosis (TB) in HIV-positive individuals. OBJECTIVE: To compare the outcome of anti-tuberculosis treatment (ATT) in HIV-positive adults diagnosed with TB through active case-finding (ACF) or passive case-finding (PCF). DESIGN: Antiretroviral therapy (ART)-naïve adults diagnosed with TB were included from two prospective cohort studies conducted in Ethiopia between September 2010 and March 2013. The PCF cohort was based at out-patient TB clinics, whereas participants in the ACF cohort were actively screened for TB by bacteriological sputum testing (smear microscopy, Xpert MTB/RIF assay, and liquid culture) without pre-selection on the basis of symptoms and signs. Outcomes of ATT were compared between participants in the two cohorts; characteristics at diagnosis and predictors of adverse outcomes were analysed. RESULTS: Among 439 TB/HIV co-infected participants, 307 and 132 belonged to PCF and ACF cohorts, respectively. Compared with the ACF participants, hemoptysis, conjunctival pallor, bedridden status, and low mid upper-arm circumference (MUAC) were significantly more common in participants identified through PCF. Sputum smear-positivity rates among pulmonary TB cases were 44.2% and 21.1% in the PCF and ACF cohorts, respectively (p<0.001). Treatment success was ascertained in 247 (80.5%) of the participants in the PCF cohort and 102 (77.2%) of the participants in the ACF cohorts (p=0.223). Low MUAC (p=0.001) independently predicted mortality in the participants in both cohorts. CONCLUSION: Although patients identified through ACF had less advanced TB disease, ATT outcome was similar to the patients identified through PCF. To achieve a better outcome, case management in ACF strategy should be strengthened through enhanced patient-centred counselling and adherence support.
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spelling pubmed-43773222015-04-02 Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding Balcha, Taye T. Skogmar, Sten Sturegård, Erik Björkman, Per Winqvist, Niclas Glob Health Action Original Article BACKGROUND: The World Health Organization strongly recommends regular screening for tuberculosis (TB) in HIV-positive individuals. OBJECTIVE: To compare the outcome of anti-tuberculosis treatment (ATT) in HIV-positive adults diagnosed with TB through active case-finding (ACF) or passive case-finding (PCF). DESIGN: Antiretroviral therapy (ART)-naïve adults diagnosed with TB were included from two prospective cohort studies conducted in Ethiopia between September 2010 and March 2013. The PCF cohort was based at out-patient TB clinics, whereas participants in the ACF cohort were actively screened for TB by bacteriological sputum testing (smear microscopy, Xpert MTB/RIF assay, and liquid culture) without pre-selection on the basis of symptoms and signs. Outcomes of ATT were compared between participants in the two cohorts; characteristics at diagnosis and predictors of adverse outcomes were analysed. RESULTS: Among 439 TB/HIV co-infected participants, 307 and 132 belonged to PCF and ACF cohorts, respectively. Compared with the ACF participants, hemoptysis, conjunctival pallor, bedridden status, and low mid upper-arm circumference (MUAC) were significantly more common in participants identified through PCF. Sputum smear-positivity rates among pulmonary TB cases were 44.2% and 21.1% in the PCF and ACF cohorts, respectively (p<0.001). Treatment success was ascertained in 247 (80.5%) of the participants in the PCF cohort and 102 (77.2%) of the participants in the ACF cohorts (p=0.223). Low MUAC (p=0.001) independently predicted mortality in the participants in both cohorts. CONCLUSION: Although patients identified through ACF had less advanced TB disease, ATT outcome was similar to the patients identified through PCF. To achieve a better outcome, case management in ACF strategy should be strengthened through enhanced patient-centred counselling and adherence support. Co-Action Publishing 2015-03-27 /pmc/articles/PMC4377322/ /pubmed/25819037 http://dx.doi.org/10.3402/gha.v8.27048 Text en © 2015 Taye T. Balcha et al. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
spellingShingle Original Article
Balcha, Taye T.
Skogmar, Sten
Sturegård, Erik
Björkman, Per
Winqvist, Niclas
Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding
title Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding
title_full Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding
title_fullStr Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding
title_full_unstemmed Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding
title_short Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding
title_sort outcome of tuberculosis treatment in hiv-positive adults diagnosed through active versus passive case-finding
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377322/
https://www.ncbi.nlm.nih.gov/pubmed/25819037
http://dx.doi.org/10.3402/gha.v8.27048
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