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Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices

Ballif M 1 , Renner L 2 , Claude Dusingize J 3 , Leroy V 4 , Ayaya S 5 , Wools-Kaloustian K 6 Show all authors , Cortes CP 7 , McGowan CC 8 , Graber C 1 , Mandalakas AM 9 , Mofenson LM 10 , Egger M 1 , Kumara Wati KD 11 , Nallusamy R 12 , Reubenson G 13 , Davies MA 14 , Fenner L 15 , International Epidemiologic Databases to Evaluate AIDS (IeDEA) , International Epidemiologic Databases to Evaluate AIDS IeDEA

Affiliations 

  • 1 Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
  • 2 University of Ghana Medical School, Korle Bu, Accra
  • 3 Women's Equity in Access to Care & Treatment, Kigali, Rwanda
  • 4 Inserm, U897, Epidémiologie-Biostatistiques ISPED, University of Bordeaux, France
  • 5 Department of Child Health and Pediatrics, Moi University School of Medicine, Kenya
  • 6 Indiana University School of Medicine
  • 7 University of Chile School of Medicine, Santiago
  • 8 Vanderbilt University School of Medicine, Nashville, Tennessee
  • 9 Tuberculosis Initiative, Texas Children's Hospital, and Baylor College of Medicine, Houston
  • 10 Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
  • 11 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 12 Penang Hospital, Malaysia
  • 13 Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • 14 Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
  • 15 Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Switzerland
J Pediatric Infect Dis Soc, 2015 Mar;4(1):30-8.
PMID: 26407355 DOI: 10.1093/jpids/piu020

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 HIV-infected 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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