TAILIEUCHUNG - Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes

The HIV epidemic has led to large increases in the frequency of smear-negative pulmonary tuberculosis, which has poor treatment outcomes and excessive early mortality compared with smear-positive disease. We used a combination of systematic review, document analysis, and global expert opinion to review the extent of this problem. We also looked at policies of national tuberculosis control programmes for the diagnosis of smear-negative pulmonary tuberculosis to assess their coverage, identify the diagnostic diffi culties, and fi nd ways to improve the diagnosis of this type of tuberculosis, with a focus on resource-constrained settings with high HIV infection rates. We propose that the internationally recommended algorithm for. | Public Health @ Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings informing urgent policy changes Haileyesus Getahun Mark Harrington Rick O Brien Paul Nunn Lancet 2007 369 2042-49 Published Online February 28 2007 DOI SO140-6736 07 60284-0 Stop TB Department WHO Geneva Switzerland H Getahun MD P Nunn FRCP Treatment Action Group New York NY USA M Harrington MA and Foundation for Innovative New Diagnostics Geneva Switzerland R O Brien MD Correspondence to Dr Haileyesus Getahun Stop TB Department WHO 20 Avenue Appia CH-1211 Geneva 27 Switzerland The HIV epidemic has led to large increases in the frequency of smear-negative pulmonary tuberculosis which has poor treatment outcomes and excessive early mortality compared with smear-positive disease. We used a combination of systematic review document analysis and global expert opinion to review the extent of this problem. We also looked at policies of national tuberculosis control programmes for the diagnosis of smear-negative pulmonary tuberculosis to assess their coverage identify the diagnostic difficulties and find ways to improve the diagnosis of this type of tuberculosis with a focus on resource-constrained settings with high HIV infection rates. We propose that the internationally recommended algorithm for the diagnosis of smear-negative pulmonary tuberculosis should be revised to include HIV status severity of AIDS and tuberculosis and early use of chest radiography in the decision tree. Increased use of promising methods of diagnosis such as sputum liquefaction and concentration and increased availability offluorescence microscopy should be explored and encouraged. Culturing ofsputum in resource-constrained settings with high HIV infection rates should also be encouraged existing facilities should be made full use of and upgraded and effective quality-assurance systems should be used. Innovative ways to address human resources issues .

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