{"id":{"repo_id":"cape-town","oai_identifier":"oai:open.uct.ac.za:11427/30006"},"canonical_url":"https://search.dev.ndltd.org/etd/cape-town/oai:open.uct.ac.za:11427/30006","repository":{"repo_id":"cape-town","name":"University of Cape Town","base_url":"https://open.uct.ac.za/oai/request"},"display":{"title":"Optimizing Tuberculosis Diagnosis in HIV-Infected Inpatients Meeting the Criteria of Seriously Ill in the WHO Algorithm","abstract":"Background The WHO algorithm for the diagnosis of tuberculosis in seriously ill HIV-infected patients lacks a firm evidence base. We aimed to develop a clinical prediction rule for the diagnosis of tuberculosis and to determine the diagnostic utility of the Xpert MTB/RIF assay in seriously ill HIV-infected patients. Methods We conducted a prospective study among HIV-infected inpatients with any cough duration and WHO-defined danger signs. Culture-positive tuberculosis from any site was the reference standard. A priori selected variables were assessed for univariate associations with tuberculosis. The most predictive variables were assessed in a multivariate logistic regression model and used to establish a clinical prediction rule for diagnosing tuberculosis. Results We enrolled 484 participants: median age 36 years, 65·5% female, median CD4 count 89 cells/μL, and 35·3% on antiretroviral therapy. Tuberculosis was diagnosed in 52·7% of participants. The c-statistic of our clinical prediction rule (variables: cough ≥14 days, unable to walk unaided, temperature >39oC, chest radiograph assessment, haemoglobin, and white cell count) was 0·811 (95%CI 0·802, 0·819). The classic tuberculosis symptoms (fever, night sweats, weight loss) added no discriminatory value in diagnosing tuberculosis. Xpert MTB/RIF assay sensitivity was 86·3% and specificity was 96·1%. Conclusion Our clinical prediction rule had good diagnostic utility for tuberculosis among seriously ill HIV-infected inpatients. Xpert MTB/RIF assay, incorporated into the updated 2016 WHO algorithm, had high sensitivity and specificity in this population. Our findings could facilitate improved diagnosis of tuberculosis among seriously ill HIV-infected inpatients in resource-constrained settings.","abstract_html":"Background The WHO algorithm for the diagnosis of tuberculosis in seriously ill HIV-infected patients lacks a firm evidence base. We aimed to develop a clinical prediction rule for the diagnosis of tuberculosis and to determine the diagnostic utility of the Xpert MTB/RIF assay in seriously ill HIV-infected patients. Methods We conducted a prospective study among HIV-infected inpatients with any cough duration and WHO-defined danger signs. Culture-positive tuberculosis from any site was the reference standard. A priori selected variables were assessed for univariate associations with tuberculosis. The most predictive variables were assessed in a multivariate logistic regression model and used to establish a clinical prediction rule for diagnosing tuberculosis. Results We enrolled 484 participants: median age 36 years, 65·5% female, median CD4 count 89 cells/μL, and 35·3% on antiretroviral therapy. Tuberculosis was diagnosed in 52·7% of participants. The c-statistic of our clinical prediction rule (variables: cough ≥14 days, unable to walk unaided, temperature >39oC, chest radiograph assessment, haemoglobin, and white cell count) was 0·811 (95%CI 0·802, 0·819). The classic tuberculosis symptoms (fever, night sweats, weight loss) added no discriminatory value in diagnosing tuberculosis. Xpert MTB/RIF assay sensitivity was 86·3% and specificity was 96·1%. Conclusion Our clinical prediction rule had good diagnostic utility for tuberculosis among seriously ill HIV-infected inpatients. Xpert MTB/RIF assay, incorporated into the updated 2016 WHO algorithm, had high sensitivity and specificity in this population. Our findings could facilitate improved diagnosis of tuberculosis among seriously ill HIV-infected inpatients in resource-constrained settings.","abstract_has_math":false,"creators":["Griesel, Rulan"],"institution":"Department of Medicine","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Maartens, Gary","Sinxadi Phumla"],"committee_chairs":[],"committee_members":[],"year":2018,"date_issued":"2018","date_published":"2018","updated_at":"2026-07-22T22:22:49Z","subjects":[],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/11427/30006","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Maartens, Gary","Sinxadi Phumla"]},{"key":"dc:creator","label":"Author","values":["Griesel, Rulan"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2019-05-10T11:00:46Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2019-05-10T11:00:46Z"]},{"key":"dc:date.issued","label":"Date","values":["2018"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Department of Medicine"]},{"key":"dc:type","label":"Dc Type","values":["Master Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Masters"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["MMed. (Clinical Pharmacology)"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/11427/30006"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background The WHO algorithm for the diagnosis of tuberculosis in seriously ill HIV-infected patients lacks a firm evidence base. We aimed to develop a clinical prediction rule for the diagnosis of tuberculosis and to determine the diagnostic utility of the Xpert MTB/RIF assay in seriously ill HIV-infected patients. Methods We conducted a prospective study among HIV-infected inpatients with any cough duration and WHO-defined danger signs. Culture-positive tuberculosis from any site was the reference standard. A priori selected variables were assessed for univariate associations with tuberculosis. The most predictive variables were assessed in a multivariate logistic regression model and used to establish a clinical prediction rule for diagnosing tuberculosis. Results We enrolled 484 participants: median age 36 years, 65·5% female, median CD4 count 89 cells/μL, and 35·3% on antiretroviral therapy. Tuberculosis was diagnosed in 52·7% of participants. The c-statistic of our clinical prediction rule (variables: cough ≥14 days, unable to walk unaided, temperature >39oC, chest radiograph assessment, haemoglobin, and white cell count) was 0·811 (95%CI 0·802, 0·819). The classic tuberculosis symptoms (fever, night sweats, weight loss) added no discriminatory value in diagnosing tuberculosis. Xpert MTB/RIF assay sensitivity was 86·3% and specificity was 96·1%. Conclusion Our clinical prediction rule had good diagnostic utility for tuberculosis among seriously ill HIV-infected inpatients. Xpert MTB/RIF assay, incorporated into the updated 2016 WHO algorithm, had high sensitivity and specificity in this population. Our findings could facilitate improved diagnosis of tuberculosis among seriously ill HIV-infected inpatients in resource-constrained settings."]},{"key":"dc:title","label":"Title","values":["Optimizing Tuberculosis Diagnosis in HIV-Infected Inpatients Meeting the Criteria of Seriously Ill in the WHO Algorithm"]}]}],"canonical_facts":{"dc:contributor.advisor":["Maartens, Gary","Sinxadi Phumla"],"dc:creator":["Griesel, Rulan"],"dc:date.accessioned":["2019-05-10T11:00:46Z"],"dc:date.available":["2019-05-10T11:00:46Z"],"dc:date.issued":["2018"],"dc:description.abstract":["Background The WHO algorithm for the diagnosis of tuberculosis in seriously ill HIV-infected patients lacks a firm evidence base. We aimed to develop a clinical prediction rule for the diagnosis of tuberculosis and to determine the diagnostic utility of the Xpert MTB/RIF assay in seriously ill HIV-infected patients. Methods We conducted a prospective study among HIV-infected inpatients with any cough duration and WHO-defined danger signs. Culture-positive tuberculosis from any site was the reference standard. A priori selected variables were assessed for univariate associations with tuberculosis. The most predictive variables were assessed in a multivariate logistic regression model and used to establish a clinical prediction rule for diagnosing tuberculosis. Results We enrolled 484 participants: median age 36 years, 65·5% female, median CD4 count 89 cells/μL, and 35·3% on antiretroviral therapy. Tuberculosis was diagnosed in 52·7% of participants. The c-statistic of our clinical prediction rule (variables: cough ≥14 days, unable to walk unaided, temperature >39oC, chest radiograph assessment, haemoglobin, and white cell count) was 0·811 (95%CI 0·802, 0·819). The classic tuberculosis symptoms (fever, night sweats, weight loss) added no discriminatory value in diagnosing tuberculosis. Xpert MTB/RIF assay sensitivity was 86·3% and specificity was 96·1%. Conclusion Our clinical prediction rule had good diagnostic utility for tuberculosis among seriously ill HIV-infected inpatients. Xpert MTB/RIF assay, incorporated into the updated 2016 WHO algorithm, had high sensitivity and specificity in this population. Our findings could facilitate improved diagnosis of tuberculosis among seriously ill HIV-infected inpatients in resource-constrained settings."],"dc:identifier.uri":["http://hdl.handle.net/11427/30006"],"dc:publisher.department":["Department of Medicine"],"dc:title":["Optimizing Tuberculosis Diagnosis in HIV-Infected Inpatients Meeting the Criteria of Seriously Ill in the WHO Algorithm"],"dc:type":["Master Thesis"],"dc:type.qualificationlevel":["Masters"],"dc:type.qualificationname":["MMed. (Clinical Pharmacology)"]},"updated_at":"2026-07-22T22:22:49Z"}