Table 1 Comparison of TB case finding and patient management interventions for PLHIV in the retrospective and prospective cohorts
Retrospective (R) | Prospective pre-Xpert (A) | Prospective post-Xpert (B) | |
|---|---|---|---|
TB screening algorithm for adults | 1. Cough of any duration 2. Fever of any duration 3. Shortness of breath 4. Chest pain 5. Haemoptysis 6. Loss of appetite 7. Loss of weight 8. Malaise 9. Night sweats | 1. Current Cough 2. Current Fever 3. Loss of weight 4. Night sweats | 1. Current Cough 2. Current Fever 3. Loss of weight 4. Night sweats |
Number of sputa collected from patients suspected of having TB | 2 spot sputa | 4 (2 spot sputa on day 1, 1 morning sputum on day 2, and one spot sputum on day 2) | 4 (2 spot sputa on day 1, 1 morning sputum on day 2, and one spot sputum on day 2) |
Adherence to TB screening algorithms | Estimated to be low | High | High |
Specialized TB case finding nurses support TB case finding activities | No | Yes | Yes |
Regular training for clinic personnel in ICF activities | No | Yes | Yes |
Diagnostic algorithm in place | Microscopy + chest X-ray for smear-negative suspects | Microscopy + chest X-ray for smear-negative suspects | Xpert + chest X-ray for Xpert-negative suspects |
Gold standard TB diagnostic test (MGIT) at national TB reference laboratory (NTRL) | Infrequent utilization of MGIT liquid TB culture at NTRL | MGIT liquid TB culture for all patients suspected of having TB. Prior to culture, fluorescent microscopy was conducted at NTRL. | MGIT liquid TB culture for all patients suspected of having TB. Prior to culture, fluorescent microscopy was conducted at NTRL. |
TB drug resistance | Infrequent requests for TB drug resistance tests. | All positive MGIT TB cultures received: (1) LPA, (2) Phenotypic culture-based DST. | All positive MGIT TB cultures received: (1) LPA, (2) Phenotypic culture-based DST. |
Patient tracing interventions in place | Irregular attempts to trace patients late for clinic appointments through telephone calls and home visits. | Tracing of patients late for clinic appointments through telephone calls and home visits. | Tracing of patients late for clinic appointments through telephone calls and home visits. |