Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.

<h4>Background</h4>The World Health Organization recommends the screening of all people living with HIV for tuberculosis (TB) disease, followed by TB treatment, or isoniazid preventive therapy (IPT) when TB is excluded. However, the difficulty of reliably excluding TB disease has severel...

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Autores principales:	Haileyesus Getahun, Wanitchaya Kittikraisak, Charles M Heilig, Elizabeth L Corbett, Helen Ayles, Kevin P Cain, Alison D Grant, Gavin J Churchyard, Michael Kimerling, Sarita Shah, Stephen D Lawn, Robin Wood, Gary Maartens, Reuben Granich, Anand A Date, Jay K Varma
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/1a36cecec5394d9fa5cadfa75e46b2b5
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spelling	oai:doaj.org-article:1a36cecec5394d9fa5cadfa75e46b2b52021-11-18T05:41:58ZDevelopment of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.1549-12771549-167610.1371/journal.pmed.1000391https://doaj.org/article/1a36cecec5394d9fa5cadfa75e46b2b52011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21267059/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>The World Health Organization recommends the screening of all people living with HIV for tuberculosis (TB) disease, followed by TB treatment, or isoniazid preventive therapy (IPT) when TB is excluded. However, the difficulty of reliably excluding TB disease has severely limited TB screening and IPT uptake in resource-limited settings. We conducted an individual participant data meta-analysis of primary studies, aiming to identify a sensitive TB screening rule.<h4>Methods and findings</h4>We identified 12 studies that had systematically collected sputum specimens regardless of signs or symptoms, at least one mycobacterial culture, clinical symptoms, and HIV and TB disease status. Bivariate random-effects meta-analysis and the hierarchical summary relative operating characteristic curves were used to evaluate the screening performance of all combinations of variables of interest. TB disease was diagnosed in 557 (5.8%) of 9,626 people living with HIV. The primary analysis included 8,148 people living with HIV who could be evaluated on five symptoms from nine of the 12 studies. The median age was 34 years. The best performing rule was the presence of any one of: current cough (any duration), fever, night sweats, or weight loss. The overall sensitivity of this rule was 78.9% (95% confidence interval [CI] 58.3%-90.9%) and specificity was 49.6% (95% CI 29.2%-70.1%). Its sensitivity increased to 90.1% (95% CI 76.3%-96.2%) among participants selected from clinical settings and to 88.0% (95% CI 76.1%-94.4%) among those who were not previously screened for TB. Negative predictive value was 97.7% (95% CI 97.4%-98.0%) and 90.0% (95% CI 88.6%-91.3%) at 5% and 20% prevalence of TB among people living with HIV, respectively. Abnormal chest radiographic findings increased the sensitivity of the rule by 11.7% (90.6% versus 78.9%) with a reduction of specificity by 10.7% (49.6% versus 38.9%).<h4>Conclusions</h4>Absence of all of current cough, fever, night sweats, and weight loss can identify a subset of people living with HIV who have a very low probability of having TB disease. A simplified screening rule using any one of these symptoms can be used in resource-constrained settings to identify people living with HIV in need of further diagnostic assessment for TB. Use of this algorithm should result in earlier TB diagnosis and treatment, and should allow for substantial scale-up of IPT.Haileyesus GetahunWanitchaya KittikraisakCharles M HeiligElizabeth L CorbettHelen AylesKevin P CainAlison D GrantGavin J ChurchyardMichael KimerlingSarita ShahStephen D LawnRobin WoodGary MaartensReuben GranichAnand A DateJay K VarmaPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 8, Iss 1, p e1000391 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Haileyesus Getahun Wanitchaya Kittikraisak Charles M Heilig Elizabeth L Corbett Helen Ayles Kevin P Cain Alison D Grant Gavin J Churchyard Michael Kimerling Sarita Shah Stephen D Lawn Robin Wood Gary Maartens Reuben Granich Anand A Date Jay K Varma Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.
description	<h4>Background</h4>The World Health Organization recommends the screening of all people living with HIV for tuberculosis (TB) disease, followed by TB treatment, or isoniazid preventive therapy (IPT) when TB is excluded. However, the difficulty of reliably excluding TB disease has severely limited TB screening and IPT uptake in resource-limited settings. We conducted an individual participant data meta-analysis of primary studies, aiming to identify a sensitive TB screening rule.<h4>Methods and findings</h4>We identified 12 studies that had systematically collected sputum specimens regardless of signs or symptoms, at least one mycobacterial culture, clinical symptoms, and HIV and TB disease status. Bivariate random-effects meta-analysis and the hierarchical summary relative operating characteristic curves were used to evaluate the screening performance of all combinations of variables of interest. TB disease was diagnosed in 557 (5.8%) of 9,626 people living with HIV. The primary analysis included 8,148 people living with HIV who could be evaluated on five symptoms from nine of the 12 studies. The median age was 34 years. The best performing rule was the presence of any one of: current cough (any duration), fever, night sweats, or weight loss. The overall sensitivity of this rule was 78.9% (95% confidence interval [CI] 58.3%-90.9%) and specificity was 49.6% (95% CI 29.2%-70.1%). Its sensitivity increased to 90.1% (95% CI 76.3%-96.2%) among participants selected from clinical settings and to 88.0% (95% CI 76.1%-94.4%) among those who were not previously screened for TB. Negative predictive value was 97.7% (95% CI 97.4%-98.0%) and 90.0% (95% CI 88.6%-91.3%) at 5% and 20% prevalence of TB among people living with HIV, respectively. Abnormal chest radiographic findings increased the sensitivity of the rule by 11.7% (90.6% versus 78.9%) with a reduction of specificity by 10.7% (49.6% versus 38.9%).<h4>Conclusions</h4>Absence of all of current cough, fever, night sweats, and weight loss can identify a subset of people living with HIV who have a very low probability of having TB disease. A simplified screening rule using any one of these symptoms can be used in resource-constrained settings to identify people living with HIV in need of further diagnostic assessment for TB. Use of this algorithm should result in earlier TB diagnosis and treatment, and should allow for substantial scale-up of IPT.
format	article
author	Haileyesus Getahun Wanitchaya Kittikraisak Charles M Heilig Elizabeth L Corbett Helen Ayles Kevin P Cain Alison D Grant Gavin J Churchyard Michael Kimerling Sarita Shah Stephen D Lawn Robin Wood Gary Maartens Reuben Granich Anand A Date Jay K Varma
author_facet	Haileyesus Getahun Wanitchaya Kittikraisak Charles M Heilig Elizabeth L Corbett Helen Ayles Kevin P Cain Alison D Grant Gavin J Churchyard Michael Kimerling Sarita Shah Stephen D Lawn Robin Wood Gary Maartens Reuben Granich Anand A Date Jay K Varma
author_sort	Haileyesus Getahun
title	Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.
title_short	Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.
title_full	Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.
title_fullStr	Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.
title_full_unstemmed	Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.
title_sort	development of a standardized screening rule for tuberculosis in people living with hiv in resource-constrained settings: individual participant data meta-analysis of observational studies.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/1a36cecec5394d9fa5cadfa75e46b2b5
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Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies.

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