Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs

BACKGROUND: Tuberculosis (TB) screening in Prevention of Mother-To-Child Transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. METHODS : As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-tosize sampling with oversampling in a high human immunodeficiency virus (HIV) prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers, and associations with infant cofactors were determined. R E SULT S : Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (P 0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (P 0.02) and non-specific TB symptoms, including cough (P 0.003), fever (P 0.05), and difficulty breathing (P 0.01). TB exposure was reported by 11% of the women, and 15% of the TBexposed women received isoniazid preventive therapy. CONCLUS IONS : Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.