Yield of undetected tuberculosis and human immunodeficiency virus coinfection from active case finding in urban Uganda.
J N Sekandi, J List, H Luzze, X-P Yin, K Dobbin, P S Corso, J Oloya, A Okwera, C C Whalen
Author Information
J N Sekandi: College of Public Health, University of Georgia, Athens, Georgia, USA; and School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
J List: Yale Primary Care Program, Yale University School of Medicine, New Haven, Connecticut, USA.
H Luzze: Department of Clinical Services, Ministry of Health, Kampala, Uganda.
X-P Yin: College of Public Health, University of Georgia, Athens, Georgia, USA.
K Dobbin: College of Public Health, University of Georgia, Athens, Georgia, USA.
P S Corso: College of Public Health, University of Georgia, Athens, Georgia, USA.
J Oloya: College of Public Health, University of Georgia, Athens, Georgia, USA.
A Okwera: National TB Treatment Center, School of Medicine, Makerere University, Mulago, Uganda.
C C Whalen: College of Public Health, University of Georgia, Athens, Georgia, USA.
OBJECTIVES: To determine the yield of undetected active tuberculosis (TB), TB and human immunodeficiency virus (HIV) coinfection and the number needed to screen (NNS) to detect a case using active case finding (ACF) in an urban community in Kampala, Uganda. METHODS: In a door-to-door survey conducted in Rubaga community from January 2008 to June 2009, residents aged ≥15 years were screened for chronic cough (≥2 weeks) and tested for TB disease using smear microscopy and/or culture. Rapid testing was used to screen for HIV infection. The NNS to detect one case was calculated based on population screened and undetected cases found. RESULTS: Of 5102 participants, 3868 (75.8%) were females; the median age was 24 years (IQR 20-30). Of 199 (4%) with chronic cough, 160 (80.4%) submitted sputum, of whom 39 (24.4%, 95%CI 17.4-31.5) had undetected active TB and 13 (8.1%, 95%CI 6.7-22.9) were TB-HIV co-infected. The NNS to detect one TB case was 131 in the whole study population, but only five among the subgroup with chronic cough. CONCLUSION: ACF obtained a high yield of previously undetected active TB and TB-HIV cases. The NNS in the general population was 131, but the number needed to test in persons with chronic cough was five. These findings suggest that boosting the identification of persons with chronic cough may increase the overall efficiency of TB case detection at a community level.
References
Int J Tuberc Lung Dis. 2012 Nov;16(11):1477-84
[PMID: 22964038]
