Abstract
Background: Tuberculosis (TB) is generally well controlled in Malaysia, but remains an important problem in the nation’s eastern states. In order to better understand factors contributing to high TB rates in the eastern state of Sabah, our aims were to describe characteristics of patients with TB at a large outpatient clinic, and determine the prevalence of HIV co-infection. Additionally, we sought to test sensitivity and specificity of the locally-available point-of-care HIV test kits.
Methods: We enrolled consenting adults with smear-positive
pulmonary TB for a 2-year period at Luyang Clinic, Kota Kinabalu, Malaysia.
Participants were questioned about ethnicity, smoking, prior TB, disease
duration, symptoms and comorbidities. Chest radiographs were scored using a previously
devised tool. HIV was tested after counselling using 2 point-of-care tests for
each patient: the test routinely in use at the TB clinic (either Advanced
Quality™ Rapid Anti-HIV 1&2, FACTS anti-HIV 1/2 RAPID or HIV (1 + 2)
Antibody Colloidal Gold), and a comparator test (Abbott Determine™ HIV-1/2,
Inverness Medical). Positive tests were confirmed by enzyme immunoassay (EIA),
particle agglutination and line immunoassay.
Results: 176 participants were enrolled; 59 (33.5%) were
non-Malaysians and 104 (59.1%) were male. Smoking rates were high (81/104
males, 77.9%), most had cavitary disease (51/145, 64.8%), and 81/176 (46.0%)
had haemoptysis. The median period of symptoms prior to treatment onset was 8
weeks. Diabetes was present in 12. People with diabetes or other comorbidities
had less severe TB, suggesting different healthcare seeking behaviours in this
group. All participants consented to HIV testing: three (1.7%) were positive
according to Determine™ and EIA, but one of these tested negative on the point-of-care
test available at the clinic (Advanced Quality™ Rapid Anti-HIV 1&2). The
low number of positive tests and changes in locally-available test type meant
that accurate estimates of sensitivity and specificity were not possible.
Conclusion: Patients had advanced disease at diagnosis, long
diagnostic delays, low HIV co-infection rates, high smoking rates among males,
and migrants may be over-represented. These findings provide important insights
to guide local TB control efforts. Caution is required in using some
point-of-care HIV tests, and ongoing quality control measures are of major
importance.
Original language | English |
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Article number | 32 |
Pages (from-to) | 1-9 |
Number of pages | 9 |
Journal | BMC Infectious Diseases |
Volume | 15 |
DOIs | |
Publication status | Published - 31 Jan 2015 |