TB or not TB: A data-driven approach to identify putative 55

pulmonary TB among adolescents in resource-constrained settings

Siyanai Zhou1; Roxanna Haghighat2; Mark Orkin3; Elona Toska1,2; Lucie Cluver2,4
1AIDSand Society Research Unit, Centre for Social Science Research, University of Cape Town, South Africa, 2Department of Social Policy & Intervention, University of Oxford, UK, 3MRC
Development Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa, 4Department of Psychiatry and Mental Health,
University of Cape Town, South Africa. zhou.siyah@gmail.com

PROBLEM STATEMENT OBJECTIVE

• Tuberculosis (TB) is a chronic infectious disease mainly caused by a To estimate and validate rates of pulmonary TB infection
bacterium called Mycobacterium tuberculosis. using patterns of self-reported TB symptoms from a
• TB is the top infectious killer worldwide and among people living with HIV South African study - Mzantsi Wakho - the world’s largest
(WHO 2017) due to antimicrobial resistance. cohort of adolescents living with HIV.
• Incidence rate of 454,000 active TB in 2015 (WHO) - >60% of these
cases among HIV-positive. (SA NDOH 2017).
• 25,000 TB-related deaths in 2015 (WHO) – excluding HIV+/TB+ co-
METHODS AND ANALYSES FLOW
infections
• Despite progress made, there have been gaps in TB detection and N=1454 @ follow-up: – 7 symptoms (past 12 months)
treatment. (n=1053, HIV positive)
• South Africa has a long history of high tuberculosis burden and currently
about 80% of the population is infected with latent TB rather than active TB
Latent Class Analysis for 2,3,4 classes
disease. (full sample)
• The most effective TB diagnostic tools (sputum, Gen-Expert) are expensive
and not accessible to all TB suspects, especially resource young people.
• Self-reported symptom-based TB diagnosis is the norm, but flawed, and 2-class model 3-class model 4-class model
has not been evaluated for adolescents.

Logistic Regressions to validate LCA classes using 2 TB

Self-reported TB n=761 213 (TB+) 28% outcomes (sub-sample)
TB diagnosis in patient medical records n=711 47 (TB+) 6.6%

Associations between LCA group membership and socio-

demographic characteristics (full sample):
Multinomial logistic Regression

RESULTS FIGURE 1: PROFILES OF ADOLESCENTS TB SYMPTOM EXPERIENCES

We identified 3 distinct profiles of self-reported TB symptoms
(Figure 1): putative pulmonary TB, respiratory tract infections, and
1.0
Conditional symptom probability

asymptomatic class.
▪ The putative pulmonary TB class was characterized by prolonged 0.8
cough (≥3 weeks), weight loss, night sweats, chest pain, and
0.6
frequent fever.
▪ Participants in the potential respiratory tract infections class 0.4
reported experiencing productive cough, chest pain, and night
sweats, indicative of pneumonia or similar RTIs. 0.2
Regression analysis results showed that HIV status is significantly
0.0
associated with membership in both the putative pulmonary TB Cough Productive Blood Weight Sweats Chest pain Fever
(OR 1.62 [95%CI 1.0-2.62], p=0.04) and other respiratory tract cough loss
TB Symptoms
infections (OR 4.91 [95%CI 2.71- 8.87], p≤0.001), with an HIV-
TB Symptomatic (6.9%) Asymptomatic (67.7%)
pulmonary TB co-infection rate of 5.2%. RTIs (10.5%) Undefined Basket (14.9%)

CONCLUSIONS
This analysis suggests high rates of pulmonary TB, and unexpectedly, respiratory tract infections among adolescents living
with HIV. Symptom screening is key for more effective case finding and follow-up treatment in high-disease burden and
resource-constrained settings and can potentially reduce pneumonia and TB misdiagnosis.
• Methodological contribution – LCA used to compute full sample reliable TB outcome using self-reported symptoms.
• Caring for ALHIV – High rates of pulmonary TB and RTIs – driven by HIV, especially RTIs.
Implications for healthcare provisions:
• A simple three symptom-based screening detects suspect PTB with high accuracy (>70% PPV).
• Two-symptom screening (productive cough+ chest pain or sweats) detects suspect RTIs (>80% PPV).
• Basket case (undefined): high burden of HIV related physical symptoms among others.