Results of community-based TB and HIV screening among transgender women and male sex workers in Pakistan.

In Pakistan and globally, a large proportion of people with TB who are not receiving treatment are key populations with poor access to diagnosis and care. Transgender women and male sex workers (MSW) are heavily stigmatized and marginalized groups. While HIV rates are well documented among these key populations, little such data exists for TB. We engaged local organizations working with transgender women and MSW communities in Karachi and five urban cities in Sindh Province. People from the communities served as screening facilitators and treatment supporters. Verbal screening was followed by testing with Xpert MTB/RIF and HIV testing was offered. People with TB were supported through treatment. We screened 18,272 transgender women and 24,253 MSW. 8,921 (21.0%) individuals had presumptive TB and 7,472 (83.8%) provided sputum samples. We detected 438 (5.9%) people with positive results including 140 transgender women and 298 MSW. Including people diagnosed clinically, 625 people with TB were identified and 98.1% initiated treatment. Overall, 1.5% of people screened had TB, 1.7% among MSW and 1.1% among transgender women. Of 1,508 people tested for HIV, 243 had HIV infection (HIV+). The rates of TB among HIV+ transgender women (8.8%) were slightly lower than among MSW (10.3%). Previously, few attempts have been made to address TB in transgender women and MSW. Our work shows that these groups carry a significant burden of both TB and HIV in Pakistan and do not regularly access services. Effective interventions should include the engagement of community leaders and peers.

Proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To determine the proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease and its association with the severity and worsening of the symptoms of chronic obstructive pulmonary disease (COPD). METHODS: A prospective, questionnaire based, case control, analytical study was conducted in the Department of Pulmonology, Jinnah Postgraduate Medical Centre, Karachi during June 2002 to January 2005. Gastroesophageal reflux symptoms were compared between 100 chronic obstructive pulmonary disease patients who fulfilled the inclusion criteria and 150 control subjects. Both groups were interviewed according to modified version of Mayo clinic GER questionnaire. Chronic obstructive pulmonary disease patients were divided into two groups according to pulmonary function tests (PFTs) results into FEV1 <50% and FEV1 >50%. RESULTS: Chronic obstructive pulmonary disease patients had more frequent gastroesophageal symptoms than controls (25% vs. 9.33% respectively; p=0.001), heartburn/acid regurgitation (70% vs. 43.33% and 56% vs. 30.66% respectively; p-value=0.001), dysphagia (15% vs. 4%; p-value=0.002) and chronic cough (89% vs. 29.33%; p-value=0.001). Twenty six COPD patients reported respiratory symptoms associated with reflux, whereas control subjects denied such association. Of the 11 patients with frequent gastroesophageal symptoms, 10 patients increased their inhaler use (p=0.001). Frequent gastroesophageal symptoms had shown a significant association with decreased FEV1 (25 % vs. 0% p-value 0.001). In contrast Pulmonary function test results were similar among chronic obstructive pulmonary disease patients with and without gastroesophageal symptoms (48.13+20.81 vs. 50.94+23.33). Anti-reflux medication proton pump inhibitor and H2-blockers were utilized more by COPD patients as compared to control subjects. CONCLUSION: A higher proportion of frequent gastroesophageal symptoms were noted by COPD patients than control subjects and higher proportion of gastroesophageal symptoms was present in severe COPD patients.

Diagnostic yield of fast plaque TB test for rapid detection of Mycobacterium in tuberculosis suspects.

OBJECTIVE: To compare the diagnostic yield of FAST Plaque TB test with the conventional methods for detection of mycobacterium tuberculosis in sputum of Tuberculosis suspects at Jinnah Postgraduate Medical Center Karachi Pakistan. METHODS: A comparative study of diagnostic yield of FAST Plaque TB test with the culture and ZN staining, conducted from January to June 2004. RESULTS: The study was completed on 48 samples, 31 (64.58%) male and 17 females (35.42%). Half of the cases were sputum positive. Culture positive was in 17 (35.41%) and negative in 28 (58.3%) wereas 3 (6.25%) were contaminated. FAST Plaque TB test was positive in 16 (33.33%) and negative in 32 (66.6%) specimens. Out of 17 culture positive, 2 (11.7%) were negative and in 28 culture negative, 1 (3.57%) specimen was positive for FAST Plaque TB test. Out of 24 smear positive, 11 (45.83%) were negative and in 24 smear negative, 3 (12.5%) were positive, for FAST Plaque TB test. Compared to culture it has sensitivity of 86.23% and specificity of 96.42%, positive predictive value of 93.75% and negative predictive value of 93.1%. CONCLUSION: FAST Plaque TB test is a simple test that can detect viable mycobacterium in 2 days. It has a good sensitivity and specificity. The cost is three times less than the other available tests like PCR. Thus it can be useful in the diagnosis of tuberculosis as an adjunct to sputum microscopy in endemic countries.