Tuberculosis in pediatric antiretroviral therapy programs in low- and middle-income countries: Diagnosis and screening practices

Marie Ballif, Lorna Renner, Jean Claude Dusingize, Valeriane Leroy, Samuel Ayaya, Kara Wools-Kaloustian, Claudia P. Cortes, Catherine C. McGowan, Claire Graber, Anna M. Mandalakas, Lynne M. Mofenson, Matthias Egger, Ketut Dewi Kumara Wati, Revathy Nallusamy, Gary Reubenson, Mary Ann Davies, Lukas Fenner*, Samuel Ajayi, Kathryn Anastos, Jules BashiWilliam Bishai, Andrew Boulle, Paula Braitstein, Gabriela Carriquiry, Jane E. Carter, Peter Cegielski, Cleophas Chimbetete, Claudia Cortes, Mary Ann Davies, Lameck Diero, Stephany Duda, Nicolas Durier, Tanoh F. Eboua, Adrian Gasser, Elvin Geng, Joachim Charles Gnokori, Chris Hoffmann, Nzali Kancheya, Sasisopin Kiertiburanakul, Peter Kim, Diero Lameck, Charlotte Lewden, Mary Lou Lindegren, Anna Mandalakas, Mhairi Maskew, Lynne Mofenson, Mireille Mpoudi-Etame, Benson Okwara, Sam Phiri, Firas Wehbe, for the International Epidemiologic Databases to Evaluate AIDS (IeDEA)

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    10 Scopus citations


    Background. The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIVinfected children remains a major challenge. Methods. We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America.We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study. Results. Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children. Conclusions. Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected children.

    Original languageEnglish (US)
    Pages (from-to)30-38
    Number of pages9
    JournalJournal of the Pediatric Infectious Diseases Society
    Issue number1
    StatePublished - 2015


    • HIV
    • Low-income countries
    • Pediatric
    • Survey
    • Tuberculosis

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health
    • Infectious Diseases

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