Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 204, Issue -, Pages S1159-S1167Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jir411
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Funding
- KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH)
- Harvard University Center for AIDS Research (CFAR)
- Albert Einstein College of Medicine
- Einstein-Montefiore CFAR (Center for AIDS Research)
- Wellcome Trust
- Division of Aids of the National Institute of Allergy and Infectious Disease, the National Institutes of Health [1U19AI53217-01, A1058736-01A1]
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The high burden of tuberculosis (TB) among patients accessing antiretroviral treatment (ART) services in resource-limited settings is a major cause of morbidity and mortality and is associated with nosocomial transmission risk. These risks are greatly compounded by multidrug-resistant disease. Screening and diagnosis of TB in this clinical setting is difficult. However, progress has been made in defining a high-sensitivity, standardized symptom screening tool that assesses a combination of symptoms, rather than relying on report of cough alone. Moreover, newly emerging diagnostic tools show great promise in providing more rapid diagnosis of TB, which is predominantly sputum smear-negative. These include culture-based systems, simplified versions of nucleic acid amplification tests (such as the Xpert MTB/RIF assay), and detection of lipoarabinomannan antigen in urine. In addition, new molecular diagnostics now permit rapid detection of drug resistance. Further development and implementation of these tools is vital to permit rapid and effective screening for TB in ART services, which is an essential component of patient care.
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