Tuberculosis in pediatric antiretroviral therapy programs in low- and middle-income countries

Diagnosis and screening practices

for the International Epidemiologic Databases to Evaluate AIDS (IeDEA)

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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 HIVinfected 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.

Original languageEnglish (US)
Pages (from-to)30-38
Number of pages9
JournalJournal of the Pediatric Infectious Diseases Society
Volume4
Issue number1
DOIs
StatePublished - 2015
Externally publishedYes

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Tuberculosis
Pediatrics
Sputum
Microscopy
Thorax
Therapeutics
Stomach
HIV
Central America
South America
History

Keywords

  • HIV
  • Low-income countries
  • Pediatric
  • Survey
  • Tuberculosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tuberculosis in pediatric antiretroviral therapy programs in low- and middle-income countries : Diagnosis and screening practices. / for the International Epidemiologic Databases to Evaluate AIDS (IeDEA).

In: Journal of the Pediatric Infectious Diseases Society, Vol. 4, No. 1, 2015, p. 30-38.

Research output: Contribution to journalArticle

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title = "Tuberculosis in pediatric antiretroviral therapy programs in low- and middle-income countries: Diagnosis and screening practices",
abstract = "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 HIVinfected 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.",
keywords = "HIV, Low-income countries, Pediatric, Survey, Tuberculosis",
author = "{for the International Epidemiologic Databases to Evaluate AIDS (IeDEA)} and Marie Ballif and Lorna Renner and Dusingize, {Jean Claude} and Valeriane Leroy and Samuel Ayaya and Kara Wools-Kaloustian and Cortes, {Claudia P.} and McGowan, {Catherine C.} and Claire Graber and Mandalakas, {Anna M.} and Mofenson, {Lynne M.} and Matthias Egger and Wati, {Ketut Dewi Kumara} and Revathy Nallusamy and Gary Reubenson and Davies, {Mary Ann} and Lukas Fenner and Samuel Ajayi and Kathryn Anastos and Jules Bashi and William Bishai and Andrew Boulle and Paula Braitstein and Gabriela Carriquiry and Carter, {Jane E.} and Peter Cegielski and Cleophas Chimbetete and Claudia Cortes and Davies, {Mary Ann} and Lameck Diero and Stephany Duda and Nicolas Durier and Eboua, {Tanoh F.} and Adrian Gasser and Elvin Geng and Gnokori, {Joachim Charles} and Chris Hoffmann and Nzali Kancheya and Sasisopin Kiertiburanakul and Peter Kim and Diero Lameck and Charlotte Lewden and {Lou Lindegren}, Mary and Anna Mandalakas and Mhairi Maskew and Lynne Mofenson and Mireille Mpoudi-Etame and Benson Okwara and Sam Phiri and Wasana Prasitsuebsai",
year = "2015",
doi = "10.1093/jpids/piu020",
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TY - JOUR

T1 - Tuberculosis in pediatric antiretroviral therapy programs in low- and middle-income countries

T2 - Diagnosis and screening practices

AU - for the International Epidemiologic Databases to Evaluate AIDS (IeDEA)

AU - Ballif, Marie

AU - Renner, Lorna

AU - Dusingize, Jean Claude

AU - Leroy, Valeriane

AU - Ayaya, Samuel

AU - Wools-Kaloustian, Kara

AU - Cortes, Claudia P.

AU - McGowan, Catherine C.

AU - Graber, Claire

AU - Mandalakas, Anna M.

AU - Mofenson, Lynne M.

AU - Egger, Matthias

AU - Wati, Ketut Dewi Kumara

AU - Nallusamy, Revathy

AU - Reubenson, Gary

AU - Davies, Mary Ann

AU - Fenner, Lukas

AU - Ajayi, Samuel

AU - Anastos, Kathryn

AU - Bashi, Jules

AU - Bishai, William

AU - Boulle, Andrew

AU - Braitstein, Paula

AU - Carriquiry, Gabriela

AU - Carter, Jane E.

AU - Cegielski, Peter

AU - Chimbetete, Cleophas

AU - Cortes, Claudia

AU - Davies, Mary Ann

AU - Diero, Lameck

AU - Duda, Stephany

AU - Durier, Nicolas

AU - Eboua, Tanoh F.

AU - Gasser, Adrian

AU - Geng, Elvin

AU - Gnokori, Joachim Charles

AU - Hoffmann, Chris

AU - Kancheya, Nzali

AU - Kiertiburanakul, Sasisopin

AU - Kim, Peter

AU - Lameck, Diero

AU - Lewden, Charlotte

AU - Lou Lindegren, Mary

AU - Mandalakas, Anna

AU - Maskew, Mhairi

AU - Mofenson, Lynne

AU - Mpoudi-Etame, Mireille

AU - Okwara, Benson

AU - Phiri, Sam

AU - Prasitsuebsai, Wasana

PY - 2015

Y1 - 2015

N2 - 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 HIVinfected 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.

AB - 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 HIVinfected 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.

KW - HIV

KW - Low-income countries

KW - Pediatric

KW - Survey

KW - Tuberculosis

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U2 - 10.1093/jpids/piu020

DO - 10.1093/jpids/piu020

M3 - Article

VL - 4

SP - 30

EP - 38

JO - Journal of the Pediatric Infectious Diseases Society

JF - Journal of the Pediatric Infectious Diseases Society

SN - 2048-7207

IS - 1

ER -