Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
Int J Infect Dis. 2020 Mar;92S:S78-S84. doi: 10.1016/j.ijid.2020.03.012. Epub 2020 Mar 18.
Clinical scores are promising case-finding tools for tuberculosis (TB) among HIV-infected patients. The Bandim TBscore has been shown to increase the diagnostic yield among patients with presumed TB in general, but has not previously been tested among newly diagnosed HIV patients at high risk of TB.
HIV-infected patients were included in this cross-sectional study. A pre-post-intervention study design was used to assess the outcome of a change in practice, i.e. the application of a clinical score (TBscore) consisting of 13 signs and symptoms to assess the need for further TB diagnostics. Patients with a TBscore ≥2 were evaluated using smear microscopy and Xpert MTB/RIF. A TB diagnosis was made based on microbiology or clinical evaluation. The sensitivity and specificity of the TBscore were compared with those of World Health Organization symptoms.
The TB prevalence among newly enrolled HIV-infected patients during the study period was 13.4% (22/164). Using the TBscore and a diagnostic algorithm, it was possible to increase the proportion of patients started on TB treatment from 2.7% (10/367) the year before the study to 10.4% (17/164) during the study period. Five patients diagnosed with TB were not started on TB treatment as they were lost to follow-up or died. With a cut-off value of 2, the TBscore had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.5% (21/22), 36.9% (41/111), 23.1% (22/118), and 97.6% (41/42), respectively.
The TBscore is useful for standardized TB screening among HIV-infected individuals and may be a valuable tool to prioritize patients at high risk of TB.
临床评分是一种有前途的针对 HIV 感染者结核病（TB）的病例发现工具。BandimTBscore 已被证明可提高一般情况下疑似结核病患者的诊断率，但尚未在新诊断的 HIV 患者中进行测试，这些患者具有较高的结核病风险。
本研究纳入了 HIV 感染者。采用前后对照研究设计来评估实践改变的结果，即应用包含 13 项体征和症状的临床评分（TBscore）来评估是否需要进一步进行结核病诊断。TBscore≥2 的患者进行痰涂片显微镜检查和 Xpert MTB/RIF 检查。根据微生物学或临床评估来诊断结核病。将 TBscore 的敏感性和特异性与世界卫生组织症状进行比较。
在研究期间，新入组的 HIV 感染者中结核病的患病率为 13.4%（22/164）。使用 TBscore 和诊断算法，可以将开始接受结核病治疗的患者比例从研究前一年的 2.7%（10/367）提高到研究期间的 10.4%（17/164）。有 5 例诊断为结核病的患者未开始接受结核病治疗，因为他们失访或死亡。TBscore 的截断值为 2 时，其敏感性、特异性、阳性预测值和阴性预测值分别为 95.5%（21/22）、36.9%（41/111）、23.1%（22/118）和 97.6%（41/42）。
TBscore 可用于 HIV 感染者的标准化结核病筛查，可能是优先考虑结核病高危患者的有用工具。
