Intensified tuberculosis case finding among HIV-infected persons using a WHO symptom screen and Xpert® MTB/RIF

M. W. Adelman, M. Tsegaye, R. R. Kempker, T. Alebachew, K. Haile, A. Tesfaye, A. Aseffa, H. M. Blumberg

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


SETTING: Human immunodeficiency virus (HIV) clinic in Addis Ababa, Ethiopia. The World Health Organization (WHO) recommends active tuberculosis (TB) casefinding among people living with HIV (PLHIV) in highburden settings. OBJECTIVE: To evaluate the effectiveness of combining a WHO-recommended symptom screen and the Xpert® MTB/RIF test to enhance TB case finding. DESIGN: In this cross-sectional study, PLHIV were screened for TB using a WHO-recommended symptom-based algorithm (cough, fever, night sweats, weight loss). Those with a positive symptom screen (≥1 symptom) underwent diagnostic testing with smear microscopy, culture, and Xpert. RESULTS: Of 828 PLHIV (89% on antiretroviral therapy), 321 (39%) had a positive symptom screen. In multivariate analysis, an unscheduled clinic visit (aOR 3.78, 95%CI 2.69-5.32), CD4 count <100 cells/ll (aOR 2.62, 95%CI 1.23-5.59) and previous history of TB (aOR 1.62, 95%CI 1.12-2.31) were predictors of a positive symptom screen. Among those with a positive symptom screen, 6% had active pulmonary TB. Smear microscopy sensitivity for TB was poor (30%) compared to culture and Xpert. CONCLUSIONS: A positive symptom screen was common among PLHIV, creating a substantial laboratory burden. Smear microscopy had poor sensitivity for active TB disease. Given the high rate of positive symptom screen, substantial additional resources are needed to implement intensified TB case finding among PLHIV in high-burden areas.

Original languageEnglish (US)
Pages (from-to)1197-1203
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number10
StatePublished - Oct 1 2015


  • Developing countries
  • Ethiopia
  • Implementation science
  • Operational research

ASJC Scopus subject areas

  • Medicine(all)


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