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A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa

Author

Listed:
  • 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

Abstract

Background: 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. Objective: To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation. Design: Cohort study exploring a TB testing algorithm. Setting: HIV clinics, South Africa. Participants: 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. Outcome: 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. Results: 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 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. Conclusion: Our clinical score may help prioritise TB investigation among symptomatic individuals.

Suggested Citation

  • 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 Sinano, 2017. "A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-20, August.
    • Handle: RePEc:plo:pone00:0181519
    DOI: 10.1371/journal.pone.0181519
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    References listed on IDEAS

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    1. Rajagopal, 2014. "The Human Factors," Palgrave Macmillan Books, in: Architecting Enterprise, chapter 9, pages 225-249, Palgrave Macmillan.
    2. Kelemu Tilahun Kibret & Alemayehu Worku Yalew & Belaineh Girma Belaineh & Muluken Melese Asres, 2013. "Determinant Factors Associated with Occurrence of Tuberculosis among Adult People Living with HIV after Antiretroviral Treatment Initiation in Addis Ababa, Ethiopia: A Case Control Study," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-8, May.
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