Evaluation of the 2007 WHO Guideline to Improve the Diagnosis of Tuberculosis in Ambulatory HIV-Positive Adults 英文参考文献.docVIP

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Evaluation of the 2007 WHO Guideline to Improve the Diagnosis of Tuberculosis in Ambulatory HIV-Positive Adults 英文参考文献.doc

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Evaluation of the 2007 WHO Guideline to Improve the Diagnosis of Tuberculosis in Ambulatory HIV-Positive Adults 英文参考文献

Evaluationofthe2007WHOGuidelinetoImprovethe DiagnosisofTuberculosisinAmbulatoryHIV-Positive Adults Olivier Koole1*, Sopheak Thai2, Kim Eam Khun 3, Reaksmey Pe 2, Johan van Griensven 1, Ludwig Apers 1, Jef Van den Ende1, Tan Eang Mao3, Lutgarde Lynen1 1InstituteofTropicalMedicine,Antwerp,Belgium, 2SihanoukHospitalCenterofHOPE(SHCH),PhnomPenh,Cambodia, 3NationalCenterforTBandLeprosyControl (CENAT),PhnomPenh,Cambodia Abstract Background:In2007WHOissuedaguidelinetoimprovethediagnosisofsmear-negativeandextrapulmonarytuberculosis (EPTB)inHIV-positivepatients.ThisguidelinereliesheavilyontheacceptanceofHIV-testingandavailabilityofchestX-rays. MethodsandFindings:CohortstudyofTBsuspectsinfourtuberculosis(TB)clinicsinPhnomPenh,Cambodia.Weassessed the operational performance of the guideline, the incremental yield of investigations, and the diagnostic accuracy for smear-negativetuberculosisinHIV-positivepatientsusingculturepositivityasreferencestandard.1,147(68.9%)of1,665TB suspectspresentedwithunknownHIVstatus,1,124(98.0%)agreedtobetested,79(7.0%)wereHIV-positive.Compliance with the guideline for chest X-rays and sputum culture requests was 97.1% and 98.3% respectively. Only 35 of 79 HIV- positivepatients(44.3%)withachestX-raysuggestiveofTBstartedTBtreatmentwithin10days.105of442HIV-positiveTB suspects started TB treatment (56.2% smear-negative pulmonary TB (PTB), 28.6% smear-positive PTB, 15.2% EPTB). The mediantimetoTBtreatmentinitiationwas5days(IQR:2–13days),rangingfrom2days(IQR:1–11.5days)forEPTB,over2.5 days(IQR:1–4days)forsmear-positivePTBto9days(IQR:3–17days)forsmear-negativePTB.Amongthe34smear-negative TBpatientswithaconfirmeddiagnosis,theincrementalyieldofchestX-ray,clinicalsuspicionorabdominalultrasound,and culturewas41.2%,17.6%and41.2%respectively.Thesensitivityandspecificityofthealgorithmtodiagnosesmear-negative TBinHIV-positiveTBsuspectswas58.8%(95%CI:42.2%–73.6%)and79.4%(95%CI:74.8%–82.4%)respectively. Conclusions:Pendingpoint-o