Cost-effectiveness of point-of-care digital chest-x-ray in HIV patients with pulmonary mycobacterial infections in Nigeria

BMC Infectious Diseases

William Blattner²  Joshua Obasanya¹  Laura Hungerford³  Alash’le Abimiku²  Samer S El-Kamary³  Gambo Aliyu⁴ 

[1] National Tuberculosis and Leprosy Training Center, Zaria, Nigeria;Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA;Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA;Health and Human Services, Federal Capital Territory, Abuja, Nigeria

关键词: Nigeria;    Non-tuberculosis mycobacteria;    Tuberculosis;    HIV;    Digital chest-x-ray;   

Others  :  1118044
DOI  :  10.1186/s12879-014-0675-0

 received in 2014-06-24, accepted in 2014-12-01,  发布年份 2014

【 摘 要 】

Background

Chest-x-ray is routinely used in the diagnosis of smear negative tuberculosis (TB). This study assesses the incremental cost per true positive test of a point-of-care digital chest-x-ray, in the diagnosis of pulmonary mycobacterial infections among HIV patients with presumed tuberculosis undetected by smear microscopy.

Methods

Consecutive patients with clinical suspicion of pulmonary tuberculosis were serially tested for Human immunodeficiency virus (HIV), their sputum examined for Acid Fast Bacilli then cultured in broth and solid media. Cultures characterized as tuberculous (M.tb) and non-tuberculous (NTM) mycobacteria by Hain assays were used as gold standards. A chest-x-ray was classified as: (1) consistent for TB, (2) not consistent for TB and (3) no pathology.

Results

Of the 1391 suspected cases enrolled, complete data were available for 952 (68%): 753/952 (79%) had negative smear tests while 150/753 (20%) had cultures positive for TB. Of those, 82/150 (55%) had chest-x-ray signs consistent with TB and 29/82 (35%) were positive for HIV. Within the co-infected, 9/29 (31%) had NTM infections. Among all suspects, the cost per positive case detected using smear microscopy test was $52.84; the overall incremental cost per positive case using chest-x-ray in smear negatives was $23.42, and in smear negative, HIV positive patients the cost was $15.77.

Conclusion

Point-of-care chest-x-ray is a cost-effective diagnostic tool for smear negative HIV positive patients with pulmonary mycobacterial infection.

【 授权许可】

   
2014 Aliyu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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