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HIV Infection Does Not Affect Active Case Finding of Tuberculosis in South African Gold Miners

¹ Aurum Institute for Health Research, Parktown, Johannesburg, South Africa; and ² London School of Hygiene and Tropical Medicine, London, United Kingdom

Correspondence and requests for reprints should be addressed to James Lewis, B.A., M.Sc., Ph.D., Aurum Institute for Health Research, Postnet Suite 300, Private Bag X 30500, Houghton, Johannesburg, South Africa 2041. E-mail: jlewis{at}auruminstitute.org

Rationale: Gold miners in South Africa undergo annual radiological screening for tuberculosis in an occupational health center of a gold mining company, but the optimal screening algorithm is unclear.

Objectives: To evaluate methods for active case detection of tuberculosis.

Methods: A sequential sample of miners attending annual medical examination was screened for tuberculosis using a symptom questionnaire, chest radiograph, and two sputum specimens for microscopy and culture.

Measurements and Main Results: There were 1,955 miners included in this study; all were male with a median age of 41 years (range, 20–61 yr). Presence of at least one of a trio of symptoms (new or worsening cough, night sweats, or weight loss) had similar sensitivity (29.4%) to either chest radiograph (25.5%) or sputum smear (25.5%). These sensitivities did not differ by HIV status. Presence of one or more elements of the symptom trio and/or new radiological abnormality substantially increased sensitivity to 49.0%. Specificity of the symptom trio was higher in HIV-uninfected (91.8%) than in HIV-infected persons (88.2%; P = 0.018). Specificity of chest radiography and smear were similar (98.7% and 99.0%, respectively) and did not differ by HIV status (both P values > 0.8).

Conclusions: In a population of gold miners who undergo regular radiological screening, the addition of chest radiography to symptom screening substantially improved the sensitivity and positive predictive value. HIV infection did not alter the sensitivity of the screening tool.

Key Words: tuberculosis • HIV infection • case finding

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The World Health Organization Stop TB strategy includes tuberculosis case finding; however, the optimal tuberculosis screening algorithm and the impact of HIV on screening remain unclear. What This Study Adds to the Field The results of this study demonstrate that the addition of chest radiography to symptom screening significantly increases sensitivity with minimal loss of specificity and that the performance of tuberculosis screening is unaffected by HIV. These results will be used to inform international recommendations on the optimum tuberculosis screening strategy and encourage use of tuberculosis screening in high HIV prevalence settings.

 

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