Impact of a computer system as a triage tool in the management of pulmonary tuberculosis in a HIV reference center in Brazil

Libório, Mariana Pitombeira; Kritski, Afrânio; Almeida, Isabela Neves de; Miranda, Pryscila Fernandes Campino; Mesquita, Jacó Ricarte Lima de; Mota, Rosa Maria Salani; Sousa, George Jó Bezerra; Pires Neto, Roberto da Justa; Leitão, Terezinha do Menino Jesus Silva

doi:10.1590/0037-8682-0451-20

Mariana Pitombeira Libório

Universidade Federal do Ceará, Faculdade de Medicina, Programa de Mestrado em Saúde Pública, Fortaleza, CE, Brasil.

Secretaria da Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil.

Universidade de Fortaleza, Faculdade de Medicina, Fortaleza, CE, Brasil.

https://orcid.org/0000-0003-1187-2309

Afrânio Kritski

Universidade Federal do Rio de Janeiro, Programa Acadêmico de Tuberculose, Faculdade de Medicina, Rio de Janeiro, RJ, Brasil.

https://orcid.org/0000-0002-5900-6007

Isabela Neves de Almeida

Universidade Federal de Ouro Preto, Escola de Farmácia, Departamento de Análises Clínicas, Ouro Preto, MG, Brasil.

https://orcid.org/0000-0001-6152-7648

Pryscila Fernandes Campino Miranda

Universidade Federal do Rio de Janeiro, Programa Acadêmico de Tuberculose, Faculdade de Medicina, Rio de Janeiro, RJ, Brasil.

https://orcid.org/0000-0002-5828-4072

Jacó Ricarte Lima de Mesquita

Secretaria da Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil.

https://orcid.org/0000-0003-2505-9802

Rosa Maria Salani Mota

Universidade Federal do Ceará, Faculdade de Medicina, Programa de Mestrado em Saúde Pública, Fortaleza, CE, Brasil.

https://orcid.org/0000-0002-3347-8372

George Jó Bezerra Sousa

Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brasil.

https://orcid.org/0000-0003-0291-6613

Roberto da Justa Pires Neto

Universidade Federal do Ceará, Faculdade de Medicina, Programa de Mestrado em Saúde Pública, Fortaleza, CE, Brasil.

Secretaria da Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil.

https://orcid.org/0000-0003-0291-9523

Terezinha do Menino Jesus Silva Leitão

Universidade Federal do Ceará, Faculdade de Medicina, Programa de Mestrado em Saúde Pública, Fortaleza, CE, Brasil.

Secretaria da Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil.

https://orcid.org/0000-0002-3301-3057

Corresponding author: Terezinha do Menino Jesus Silva Leitão. e-mail:tsilva@ufc.br

Authors’ contribution: MPL: Conceptualization of the study, validation of data, lead the investigation, wrote the original draft of the article, final approval of the version to be submitted. ALK: Conception and design of the study, Lead the data curation, Lead the Funding acquisition, Analysis and interpretation of data, design the methodology of the study, validation of data, supervision and administration of the project, Drafting the article, Final approval of the version to be submitted. INA: Supporting the data curation, validation of data, supporting the investigation, wrote the original draft of the article, final approval of the version to be submitted and coordination of submission. PFCM: Conceptualization of the study, validation of data, analysis and interpretation of data, supporting the investigation, wrote the original draft of the article, final approval of the version to be submitted. JRLM: Design the methodology of the study, analysis and interpretation of data, supporting the investigation, final approval of the version to be submitted. RMSM: Supporting the investigation, wrote the original draft of the article, final approval of the version to be submitted. GKBS: Validation of data, analysis and interpretation of data, supporting the investigation, wrote the original draft of the article, final approval of the version to be submitted. RJPN: Design the methodology of the study, wrote the original draft of the article, final approval of the version to be submitted. TMJSL: Conceptualization of the study, design the methodology of the study, validation of data, supervision and administration of the project, analysis and interpretation of data, wrote the original draft of the article, final approval of the version to be submitted.

Conflict of Interest: The authors declare that there is no conflict of interest.

Neural TB Score Classification
	Non-TB/Low Probability		Medium/High Probability		Total		p*
	n	%	n	%	n	%
Sex
Female	52	58.4	29	25.7	81	40.1	<0.001
Male	37	41.6	84	74.3	121	59.9
Race (skin color)
White/yellow	18	20.2	21	18.6	39	19.3	0.853
Brown/black	71	79.8	92	81.4	163	80.7
Marital status
Married/stable union	35	39.3	49	43.4	84	41.6	0.639
Divorced/separated/widower	15	16.9	14	12.4	29	14.4
Single	39	43.8	50	44.2	89	44.1
Years of schooling
Illiterate/<4 years	19	21.3	23	20.4	42	20.8	0.213
4 to <9 years	26	29.2	43	38.1	69	34.2
9 years	15	16.9	24	21.2	39	19.3
≥12 years	29	32.6	23	20.4	52	25.7
Socioeconomic level (minimum wage)
≥6	10	11.2	6	5.3	16	7.9	0.239
4-5	39	43.8	47	41.6	86	42.6
≤3	40	44.9	60	53.1	100	49.5
Weight loss
No	49	55.7	97	85.8	146	72.6	<0.001
Yes	39	44.3	16	14.2	55	27.4
% Weight loss
≤10%	71	80.7	55	48.7	126	62.7	<0.001
>10%	17	19.3	58	51.3	75	37.3
Cough
No	1	1.1	0	0.0	1	0.5	0.441
Yes	88	98.9	113	100.0	201	99.5
Length of cough (weeks)
0 \|-- 3 weeks	31	35.6	30	28.0	61	31.4	0.279
≥3 weeks	56	64.4	77	72.0	133	68.6
Productive cough
No	16	18.0	25	22.1	41	20.3	0.478
Yes	73	82.0	88	77.9	161	79.7
Length of productive cough (weeks)
0 \|-- 3 weeks	45	52.3	60	56.1	105	54.4	0.663
≥3 weeks	41	47.7	47	43.9	88	45.6
Fever
No	47	52.8	11	9.8	58	28.9	<0.001
Yes	42	47.2	101	90.2	143	71.1
Length of fever (weeks)
0 \|-- 3 weeks	67	77.0	58	53.7	125	64.1	0.001
≥3 weeks	20	23.0	50	46.3	70	35.9
Blood in sputum
No	72	81.8	72	63.7	144	71.6	0.005
Yes	16	18.2	41	36.3	57	28.4
Night sweats
No	69	77.5	47	42.0	116	57.7	<0.001
Yes	20	22.5	65	58.0	85	42.3
Appetite loss
No	39	43.8	25	22.1	64	31.7	0.001
Yes	50	56.2	88	77.9	138	68.3
Dyspnea
No	35	39.8	39	34.5	74	36.8	0.464
Yes	53	60.2	74	65.5	127	63.2

Accuracy of the NCS-TB
Sensitivity	95% CI*	Specificity	95% CI*
76.5%	61.4-91.5	48.2%	40.6-55.8
TB Prevalence**
	1.0%	4.0%	10%	24.8%
Positive Predictive Value	1.5%	5.8%	14%	33%
Negative Predictive Value	99.5%	98%	94.9%	86%

	Study Phase
	Baseline		Intervention		Total		p*
	n	%	N	%	n	%
Sex
Female	49	30.4	81	40.1	130	35.8	0.062
Male	112	69.6	121	59.9	233	64.2
Race (skin color)
White/yellow	36	22.6	39	19.3	75	20.8	0.514
Brown/black	123	77.4	163	80.7	286	79.2
Marital status
Married/Stable union	56	34.8	84	41.6	140	38.6	0.305
Divorced/separated/widower	21	13.0	29	14.4	50	13.8
Single	84	52.2	89	44.1	173	47.7
Years of schooling
Illiterate/<4 years	36	22.4	42	20.8	78	21.5	0.949
4 to <9 years	52	32.3	69	34.2	121	33.3
9 years	29	18.0	39	19.3	68	18.7
≥12 years	44	27.3	52	25.7	96	26.4
Socioeconomic level (minimum wage)
≥6	8	5.0	16	7.9	24	6.6	0.086
4-5	55	34.2	86	42.6	141	38.8
≤3	98	60.9	100	49.5	198	54.5
Smoker
No	72	44.7	83	41.1	155	42.7	0.076
Yes	42	26.1	74	36.6	116	32.0
Ex-smoker	47	29.2	45	22.3	92	25.3
CAGE criteria**
Negative	137	86.2	166	85.1	303	85.6	0.879
Positive	22	13.8	29	14.9	51	14.4
Illicit drug use
No	131	88.5	184	91.1	315	90.0	0.473
Yes/Ex-user	17	11.5	18	8.9	35	10.0
HIV (HIV + pre-screen and/or post-screen)
Negative	22	28.9	9	12.0	31	20.5	0.015
Positive	54	71.1	66	88.0	120	79.4

	OR	95% CI^¥
Sex
Female	1.000	-
Male	1.534	1.013-2.324
Years of schooling
Illiterate/<4 years	1.582	0.842-2.975
4 to <9 years	1.927	1.099-3.379
9 years	2.420	1.353-4.328
≥12 years	1.000	-
Length of productive cough (weeks)
0 \|-- 3 weeks	1.000	-
≥3 weeks	1.769	1.199 -2.608
Fever
No	1.000	-
Yes	2.262	1.316-3.888
Length of fever (weeks)
0 \|-- 3 weeks	1.000	-
≥3 weeks	1.729	1.196-2.499
Night sweats
No	1.000	-
Yes	1.614	1.128-2.311
Appetite loss
No	1.000	-
Yes	1.927	1.207-3.075
Coryza, nose pruritus, frequent sneeze
No	1.972	1.314-2.959
Yes	1.000	-

[1] Corresponding author: Terezinha do Menino Jesus Silva Leitão. e-mail:tsilva@ufc.br

Brasil

Brasil

Impact of a computer system as a triage tool in the management of pulmonary tuberculosis in a HIV reference center in Brazil

ABSTRACT

Background:

Methods:

Results:

Conclusions: