Follow-Up of HIV Positive-Sputum Smear Negative Presumptive Tuberculosis Patients in The EAPHLNP Study Site in Kenya

Abstract

Tuberculosis (TB) is a global health problem that causes ill-health among millions of people each year. The most common method for diagnosing TB worldwide was sputum smear microscopy. However the advent of HIV/AIDS has complicated the diagnosis and  management of TB with associated emergence of multidrug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB). Studies that evaluate methods for diagnosing TB and follow-up of Presumptive TB patients to verify the presence or absence of active TB are crucial for prompt diagnosis and treatment.

Objective: The study aimed to assess adherence to attend follow up clinical and sputum reexamination clinics for symptomatic HIV positive presumptive TB patients initially assumed to be TB negative. To find out at what stage HIV positive smear negative presumptive TB patients would become positive for TB with which diagnostic method within a 6 month follow up.

Methodology: This was cohort study conducted in nine East African Public Health Laboratory Networking Project study sites in Kenya.  Eligible new and previously treated presumptive TB patients i.e. a patient presenting with symptoms and signs suggestive of TB who tested positive for HIV and had sputum smear negative on initial sputum smear examination were enrolled in to the study. Study participants were expected to be followed up for repeat sputum smear examination at 2 weeks, 2, 4, and 6 months.

Results: Out of the 1323 presumptive TB patients enrolled between February 2013 and February 2014, only 201 (15.2%) were eligible for follow up and 164 (81.6%) did not return at 2 weeks for a follow up. Out of the 37 (18.4%) who returned for a follow up at 2 weeks, none was either sputum smear positive or Gene-Xpert positive. Initial sputum samples from all the 201 participants were subjected to culture. Culture results were available for only 156 patients of whom 15/156, (9.6%) were culture positive. Follow up adherence at 2 weeks was significantly associated with history of previous treatment (p-value = 0.010) but not associated with gender (p-value =0.268).

Conclusion: The high level of non-adherence to follow up among HIV positive presumptive TB patients is a cause for concern to the  national TB program. We recommend active follow up of this group who has initial sputum smear negative results using the new  diagnostic tools that are available and can diagnosis TB early. Future studies should evaluate strategies that should be put in place to ensure enhanced follow up of the presumptive TB patients as part of the protocol.

Key Words: Presumptive tuberculosis, HIV positive smear negative, Follow up