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Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and
Marie Ballif1, Lorna Renner2, Jean Claude Dusingize3
1Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.
Insights
Diagnosing childhood tuberculosis (TB) in HIV-infected children is challenging. Limited access to advanced diagnostics like Xpert MTB/RIF hinders effective screening and diagnosis in antiretroviral treatment programs.
Area of Science:
- Global Health
- Infectious Diseases
- Pediatrics
Background:
- Childhood tuberculosis (TB) affects 0.5 million children annually.
- HIV-infected children face a heightened risk of TB.
- Diagnosing TB in this vulnerable population presents significant challenges.
Purpose of the Study:
- To assess TB diagnosis and screening practices in pediatric antiretroviral treatment (ART) programs.
- To identify challenges in diagnosing TB among HIV-infected children in resource-limited settings.
Main Methods:
- A web-based questionnaire survey was conducted among 43 pediatric ART programs across 23 countries.
- Data were collected on diagnostic tool availability and screening practices for TB.
- Practices were analyzed for 146 children diagnosed with TB during the study period (March-July 2012).
Main Results:
- Sputum microscopy and chest X-rays were widely available; mycobacterial culture was available in 93% of sites.
- Induced sputum and Xpert MTB/RIF were less accessible, available in 54% and 37% of sites, respectively.
- Screening relied heavily on symptom identification (88%) and contact history (84%), with lower utilization of advanced diagnostics for confirmed TB cases.
Conclusions:
- Induced sputum and Xpert MTB/RIF are underutilized for childhood TB diagnosis in ART programs.
- Current screening methods are largely symptom-based, indicating a need for improved diagnostic capacity.
- Urgent improvements are required in low- and middle-income countries to effectively exclude and diagnose TB in HIV-infected children.
Background:
The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge.
Methods:
We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study.
Results:
Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children.
Conclusions:
Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected children.
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