Systematic case finding for tuberculosis in HIV-infected people who inject drugs: experience from Pakistan

S. Tahseen; H. Shahnawaz; U. Riaz; F. M. Khanzada; A. Hussain; W. Aslam; M. Von Euler-chelpin

doi:10.5588/ijtld.17.0390

Systematic case finding for tuberculosis in HIV-infected people who inject drugs: experience from Pakistan

S. Tahseen, H. Shahnawaz, U. Riaz, F. M. Khanzada, A. Hussain, W. Aslam, M. Von Euler-chelpin

6 Citations (Scopus)

Abstract

SETTING: Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV. OBJ ECT IVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIVinfected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom. A single sputum sample was collected regardless of symptoms, and examined using smear, Xpert® MTB/ RIF and culture. RESULT S : Of 888 PWID, 71.5% submitted a sputum sample. More TB cases were detected using Xpert (n = 25) than with smear (n = 10) or culture (n = 20). A TB prevalence of 6141 per 100 000 was estimated based on seven cases already identified as being on anti-tuberculosis treatment and 32 newly diagnosed bacteriologically confirmed TB cases. Both cough and smoking (≥10 pack-years) were associated with increased TB prevalence. Only half of the TB cases reported cough. Rifampicin resistance was reported among 10% (3/29) of newly identified cases. CONCLUS ION: TB prevalence in HIV-infected PWID was 15 times higher than in the general adult population. As a screening symptom, cough has low diagnostic value.

Original language	English
Journal	International Journal of Tuberculosis and Lung Disease
Volume	22
Issue number	2
Pages (from-to)	187-193
ISSN	1027-3719
DOIs	https://doi.org/10.5588/ijtld.17.0390
Publication status	Published - 1 Feb 2018

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title = "Systematic case finding for tuberculosis in HIV-infected people who inject drugs: experience from Pakistan",

abstract = "SETTING: Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV. OBJ ECT IVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIVinfected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom. A single sputum sample was collected regardless of symptoms, and examined using smear, Xpert{\textregistered} MTB/ RIF and culture. RESULT S : Of 888 PWID, 71.5% submitted a sputum sample. More TB cases were detected using Xpert (n = 25) than with smear (n = 10) or culture (n = 20). A TB prevalence of 6141 per 100 000 was estimated based on seven cases already identified as being on anti-tuberculosis treatment and 32 newly diagnosed bacteriologically confirmed TB cases. Both cough and smoking (≥10 pack-years) were associated with increased TB prevalence. Only half of the TB cases reported cough. Rifampicin resistance was reported among 10% (3/29) of newly identified cases. CONCLUS ION: TB prevalence in HIV-infected PWID was 15 times higher than in the general adult population. As a screening symptom, cough has low diagnostic value.",

author = "S. Tahseen and H. Shahnawaz and U. Riaz and Khanzada, {F. M.} and A. Hussain and W. Aslam and {Von Euler-chelpin}, M.",

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AU - Tahseen, S.

AU - Shahnawaz, H.

AU - Riaz, U.

AU - Khanzada, F. M.

AU - Hussain, A.

AU - Aslam, W.

AU - Von Euler-chelpin, M.

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N2 - SETTING: Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV. OBJ ECT IVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIVinfected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom. A single sputum sample was collected regardless of symptoms, and examined using smear, Xpert® MTB/ RIF and culture. RESULT S : Of 888 PWID, 71.5% submitted a sputum sample. More TB cases were detected using Xpert (n = 25) than with smear (n = 10) or culture (n = 20). A TB prevalence of 6141 per 100 000 was estimated based on seven cases already identified as being on anti-tuberculosis treatment and 32 newly diagnosed bacteriologically confirmed TB cases. Both cough and smoking (≥10 pack-years) were associated with increased TB prevalence. Only half of the TB cases reported cough. Rifampicin resistance was reported among 10% (3/29) of newly identified cases. CONCLUS ION: TB prevalence in HIV-infected PWID was 15 times higher than in the general adult population. As a screening symptom, cough has low diagnostic value.

AB - SETTING: Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV. OBJ ECT IVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIVinfected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom. A single sputum sample was collected regardless of symptoms, and examined using smear, Xpert® MTB/ RIF and culture. RESULT S : Of 888 PWID, 71.5% submitted a sputum sample. More TB cases were detected using Xpert (n = 25) than with smear (n = 10) or culture (n = 20). A TB prevalence of 6141 per 100 000 was estimated based on seven cases already identified as being on anti-tuberculosis treatment and 32 newly diagnosed bacteriologically confirmed TB cases. Both cough and smoking (≥10 pack-years) were associated with increased TB prevalence. Only half of the TB cases reported cough. Rifampicin resistance was reported among 10% (3/29) of newly identified cases. CONCLUS ION: TB prevalence in HIV-infected PWID was 15 times higher than in the general adult population. As a screening symptom, cough has low diagnostic value.

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JO - International Journal of Tuberculosis and Lung Disease

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Systematic case finding for tuberculosis in HIV-infected people who inject drugs: experience from Pakistan

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