A comparision of the yield of three tuberculosis screening modalities among people living with HIV: a retrospective quasi-experiemental studyReport as inadecuate




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BMC Public Health

, 16:1080

Health policies, systems and management in low and middle-income countries

Abstract

BackgroundThe Intensified Case Finding ICF tool was approved for TB screening in 2011; however there is still paucity of robust data comparing yields of the different ICF screening modalities. We compared yields of three different screening modalities for TB among Patients Living with HIV PLHIV in Uganda in order to inform National TB Programs on the most effective TB screening method.

MethodsThis was a retrospective quasi-experimental study conducted at an Out-Patient HIV-AIDS clinic in Uganda. We set out to determine yields of three different TB screening modalities at three time periods: 2006-07 where Passive Case Finding PCF was used. Here, no screening questions were administered; the clinician depended on the patient’s self report. In 2008-09 embedded Intensified Case Finding Tool e-ICF was used; here a data capture field was added to the patient clinical encounter forms to compel clinicians to screen for TB symptoms. In 2010-11 Independent Intensified Case Finding Tool i-ICF was used; here a screening data collection form, was used, it had the same screening questions as e-ICF. Routine clinical data, including TB status, were collected and entered into an electronic clinical care database. Analysis was done in STATA and the main outcome estimated was the proportional yield of TB cases for each screening modality.

ResultsThe overall yield of TB cases was 11.18 % over the entire period of the study 2006 – 2011. The intervention–specific yields were 1.86 % for PCF, 14.95 % for e-ICF and 12.47 % for i-ICF. Use of either e–ICF OR: 9.2, 95 % CI: 4.81-17.73 or i– ICF OR: 7.7, 95 % CI: 4.02-14.78 significantly detected more TB cases compared to PCF P <0.001. While the yields of the Active Case Finding modalities e-ICF and i-ICF were not significantly different OR: 0.98, 95 % CI 0.76-1.27, P = 0.89.

ConclusionThe active screening modalities e-ICF and i-ICF had a comparable TB yield and were eight to nine times more efficient in identifying TB cases when compared to the PCF. Cost effectiveness studies would be informative.

KeywordsIntensified case finding Uganda HIV-AIDS AbbreviationsACFActive case finding

ACPAids control program

ARTAntiretroviral therapy

BMIBasal mass index

CDRCase detection rate

CIConfidence interval

e-ICFEmbedded-intensified case finding tool

i-ICFIndependent-intensified case finding tool

NTLPNational TB and leprosy program

OROdds ratio

PProbability

PCFPassive case finding

PLHIVPeople living with HIV

PYOPerson years of observation

WHOWorld Health Organization

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Author: Michael Kakinda - Joseph K. B. Matovu - Ekwaro A. Obuku

Source: https://link.springer.com/



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