A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.
The World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications.To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV car...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5542442?pdf=render |
| _version_ | 1819051285672886272 |
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| author | Yasmeen Hanifa Katherine L Fielding Violet N Chihota Lungiswa Adonis Salome Charalambous Nicola Foster Alan Karstaedt Kerrigan McCarthy Mark P Nicol Nontobeko T Ndlovu Edina Sinanovic Faieza Sahid Wendy Stevens Anna Vassall Gavin J Churchyard Alison D Grant |
| author_facet | Yasmeen Hanifa Katherine L Fielding Violet N Chihota Lungiswa Adonis Salome Charalambous Nicola Foster Alan Karstaedt Kerrigan McCarthy Mark P Nicol Nontobeko T Ndlovu Edina Sinanovic Faieza Sahid Wendy Stevens Anna Vassall Gavin J Churchyard Alison D Grant |
| author_sort | Yasmeen Hanifa |
| collection | DOAJ |
| description | The World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications.To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation.Cohort study exploring a TB testing algorithm.HIV clinics, South Africa.Representative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model.TB, defined as "confirmed" if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and "clinical" if TB treatment started without microbiological confirmation, within six months of enrolment.Overall, 79/2602 (3.0%) participants on ART fulfilled TB case definitions, compared to 65/906 (7.2%) pre-ART. Among 1133/3508 (32.3%) participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1%) in the derivation and 58/533 (10.9%) in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART < 3 months); body mass index (continuous); CD4 (continuous); number of WHO symptoms (1 vs. >1 symptom). We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048) symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be avoided, but 3% (9/331) with TB would be missed amongst those not tested.Our clinical score may help prioritise TB investigation among symptomatic individuals. |
| first_indexed | 2024-12-21T12:01:31Z |
| format | Article |
| id | doaj.art-1e329a1d525b4b33b4ebddff659df2f0 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T12:01:31Z |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-1e329a1d525b4b33b4ebddff659df2f02022-12-21T19:04:48ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01128e018151910.1371/journal.pone.0181519A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.Yasmeen HanifaKatherine L FieldingViolet N ChihotaLungiswa AdonisSalome CharalambousNicola FosterAlan KarstaedtKerrigan McCarthyMark P NicolNontobeko T NdlovuEdina SinanovicFaieza SahidWendy StevensAnna VassallGavin J ChurchyardAlison D GrantThe World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications.To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation.Cohort study exploring a TB testing algorithm.HIV clinics, South Africa.Representative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model.TB, defined as "confirmed" if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and "clinical" if TB treatment started without microbiological confirmation, within six months of enrolment.Overall, 79/2602 (3.0%) participants on ART fulfilled TB case definitions, compared to 65/906 (7.2%) pre-ART. Among 1133/3508 (32.3%) participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1%) in the derivation and 58/533 (10.9%) in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART < 3 months); body mass index (continuous); CD4 (continuous); number of WHO symptoms (1 vs. >1 symptom). We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048) symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be avoided, but 3% (9/331) with TB would be missed amongst those not tested.Our clinical score may help prioritise TB investigation among symptomatic individuals.http://europepmc.org/articles/PMC5542442?pdf=render |
| spellingShingle | Yasmeen Hanifa Katherine L Fielding Violet N Chihota Lungiswa Adonis Salome Charalambous Nicola Foster Alan Karstaedt Kerrigan McCarthy Mark P Nicol Nontobeko T Ndlovu Edina Sinanovic Faieza Sahid Wendy Stevens Anna Vassall Gavin J Churchyard Alison D Grant A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. PLoS ONE |
| title | A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. |
| title_full | A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. |
| title_fullStr | A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. |
| title_full_unstemmed | A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. |
| title_short | A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. |
| title_sort | clinical scoring system to prioritise investigation for tuberculosis among adults attending hiv clinics in south africa |
| url | http://europepmc.org/articles/PMC5542442?pdf=render |
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