Background: Tuberculosis (TB)/HIV during pregnancy is associated with poor maternal and
infant outcomes. There are limited data on TB prevalence, optimal TB screening, and
performance of rapid diagnostics in pregnant HIV-infected women.
Methods: We conducted a cross-sectional study of HIV-infected pregnant women in western
Kenya using a standardized questionnaire, and collected sputum for smear, mycobacterial liquid
culture, GeneXpert MTB/RIF, and urine for lipoarabinomannan. We determined prevalence and
correlates of culture-confirmed pulmonary TB, and compared diagnostic performance of World
Health Organization symptom screening and rapid diagnostic tests to sputum culture.
Results: Between July 2013 and July 2014, we enrolled 306 women. Among 288 women with a
valid sputum culture result, 54% were on antiretroviral treatment, and median CD4 cell count
was 437 cell/mm3
(IQR 342-565). Prevalence of culture-confirmed pulmonary TB was 2.4% (CI
1.0-4.9%). Cough >2 weeks (p=0.04) and positive TST (>5mm, p=0.03) were associated with
pulmonary TB. Women with TB were 23-fold (95% CI 4.4-116.6) more likely to report a
household member with TB symptoms (p=0.002). WHO symptom screen (43%), AFB smear
(0%), Xpert (43%) and LAM (0%) had low sensitivity but high specificity (81%, 99%, 99% and
95%, respectively) for pulmonary TB.
Conclusion: HIV-infected pregnant women had appreciable prevalence of pulmonary TB
despite modest immunosuppression. Current TB screening and diagnostic tools perform poorly
in pregnant HIV-infected women. Adapted TB screening tools including household member TB
symptoms may be useful in this population.