Application of WHO Symptom Screening Approach by Non Clinicians in the Diagnosis of Pulmonary Tuberculosis among HIV Positive Individuals in the University of Uyo Teaching Hospital, Nigeria

Aims: Pulmonary Tuberculosis (PTB) is a major opportunistic infection and principal cause of mortality among HIV positive individuals. Its screening among this population ensures early detection, prompt treatment and reduction of mortality. This study aimed to assess the burden of hospital PTB initially identified by cough monitors , the type of confirmed PTB and the sensitivity and specificity of the four-symptom TB screening approach.

Study Design: A descriptive cross- sectional design was used.

Place And Duration of Study: The study was conducted at the Anti-Retroviral Therapy (ART) out-patient clinic of a tertiary hospital in southern Nigeria over a 9 months period between January to September, 2020.

Methodology: The medical records of adults diagnosed with HIV who were identified by non-clinicians to have at least one of the four symptoms (cough, weight loss, night sweats and fever) prescribed by WHO for PTB screening on attendance at the ART clinic of the University of Uyo Teaching Hospital, Uyo, Nigeria were reviewed. Data were analyzed using Stata version 13.0 Level of significance was set at p<.05

Results: Sixty-nine (69) out of 529 (13.0%) patients who attended the ART clinic were identified to have at least one of the four symptoms. The common PTB symptoms were cough (62, 89.9%), fever (49, 71.0%), weight loss (40, 58%) and night sweats (29, 42%). Nine (13.0%) respondents were confirmed to have rifampicin resistant PTB from Gene Xpert test. The four–symptom TB screening test had a sensitivity of 11.1%, specificity of 98.3% and a positive predictive value of 50%.

Conclusion: The use of the WHO four-symptom tuberculosis screening tool by non-clinicians, though with low sensitivity in this study, was useful in identifying drug-resistant tuberculosis in HIV positive patients when combined with Gene Xpert MTB/RIF assay.