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Evaluation of the intensified tuberculosis case finding guidelines for children living with HIV
S Sawry1, H Moultrie1, A Van Rie2
1Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Symptom screening for tuberculosis in children with HIV on antiretroviral treatment had low yield. Further research is needed to improve TB case finding and isoniazid preventive therapy eligibility criteria in this vulnerable population.
Area of Science:
- Paediatric infectious diseases
- Public health
- HIV/AIDS management
Background:
- Children living with HIV (human immunodeficiency virus) on antiretroviral treatment (ART) are at increased risk for tuberculosis (TB).
- Intensified TB case finding (ICF) and isoniazid preventive therapy (IPT) are crucial components of care for these children.
Purpose of the Study:
- To evaluate the effectiveness of symptom screening for identifying TB and determining IPT eligibility in children with HIV on ART.
- To assess the yield of current TB symptom screening protocols in a paediatric HIV clinic.
Main Methods:
- A cohort of 247 children (aged 0-8 years) receiving care at an out-patient paediatric HIV clinic in Soweto, South Africa, were systematically screened for TB symptoms over two years.
- Children with symptoms underwent further diagnostic evaluation including chest X-ray, smear microscopy, and culture.
- IPT eligibility was assessed based on World Health Organization and South African guidelines.
Main Results:
- Over 1300 TB symptom screens were conducted in 220 children. Only 3.6% of screens were positive for TB symptoms.
- The positive predictive value of symptom screening for TB was low (8.9%), with a sensitivity of 57.1%.
- While most children met WHO criteria for IPT eligibility (85.8%), very few met South African criteria (1.2%).
Conclusions:
- TB symptom screening has a poor yield in children with HIV on ART, indicating a need for improved paediatric TB screening strategies.
- Discrepancies in IPT eligibility criteria between major guidelines necessitate research to establish optimal IPT use in children on ART.
Setting:
Out-patient paediatric human immunodeficiency virus (HIV) clinic in Soweto, South Africa.
Objective:
To evaluate the yield of symptom screening for intensified tuberculosis (TB) case finding (ICF) and potential eligibility for isoniazid preventive therapy (IPT) in children living with HIV on antiretroviral treatment (ART).
Design:
A cohort of 247 children (age 0-8 years) was systematically screened for TB symptoms during the first 2 years of ART. Children with symptoms were assessed using chest X-ray, smear microscopy and culture.
Results:
Over 2 years, 1346 TB symptom screens were performed in 220 children not on anti-tuberculosis treatment. Only 48 (3.6%) screens in 39 children were positive for current cough, current fever, weight loss (>5%) or contact with a TB patient. The positive predictive value of symptom screening was 8.9% (95%CI 2.5-21.2); the sensitivity was 57.1% (95%CI 18.4-90.1). Most children (85.8%) were IPT-eligible according to World Health Organization guidelines; however, few (1.2%) were eligible according to South African guidelines.
Conclusions:
The yield of TB symptom screening was relatively poor in children on ART, highlighting the need for future research on paediatric TB symptom screening approaches in this population. The vastly different criteria for IPT eligibility between guidelines suggest that research is also needed to define the optimal use of IPT in children on ART.
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