Effect of Antiretroviral Therapy on the Diagnostic Accuracy of Symptom Screening for Intensified Tuberculosis Case Finding in a South African HIV Clinic

摘要: There is a high prevalence of previously undiagnosed tuberculosis in individuals infected with human immunodeficiency virus (HIV), especially among those about to start antiretroviral therapy (ART) [1–3]. Identifying before present symptoms reduces morbidity and mortality also the spread [4]. Intensified case finding, along isoniazid preventive (IPT) infection control, forms part World Health Organization's (WHO) “three I's” intervention strategy reduce from HIV-associated [5, 6]. WHO recommends screening for “at every visit health facility or contact worker.” Ruling out by intensified finding particularly important prior initiation IPT order offset risk resistance. In an attempt standardize HIV-infected living resource-constrained settings, undertook meta-analysis individual patient data studies conducted high-burden countries find most sensitive [1,7–16]. The presence any one current cough, fever, night sweats, weight loss had negative predictive value this symptom algorithm now recommended finding. It not known how ART will modify diagnostic performance algorithm, as none cohorts analyzed develop included patients on ART. This 2010 guidelines, mostly basis observational data. Countries affected HIV are rapidly scaling up ART, guidelines recommending earlier initiation. Because HIV-related resources being used clinics, pre-ART care often rudimentary countries. Implementing complex like may be easier clinics. Therefore, it evaluate algorithms ART. To investigate effect utility rule tuberculosis, we compared participants established prepared who underwent during evaluation IPT.