Odds of passing comprehension quizzes 1–5 compared to quiz 1 & previous quiz; odds of passing comprehension quizzes 1–5 by time since last quiz (months).

<p>Odds of passing comprehension quizzes 1–5 compared to quiz 1 & previous quiz; odds of passing comprehension quizzes 1–5 by time since last quiz (months).</p

Proportion of participants answering comprehension quiz questions 1–20 correctly (English & Setswana); Odds of answering correctly if quiz taken in English.

<p>Proportion of participants answering comprehension quiz questions 1–20 correctly (English & Setswana); Odds of answering correctly if quiz taken in English.</p

Number of comprehension quizzes completed by HIV-infected adults enrolled in a tuberculosis prevention trial, Botswana 2004–2008.

<p>Comprehension quizzes were administered at screening for enrolment (Quiz 1) and then every 6 months for a period of 36 months. However because not all participants were administered all quizzes, “Quiz 2” – for instance – refers to the second quiz taken regardless of the time elapsed since Quiz 1.</p

Unadjusted and adjusted odds of passing quizzes 1–5 by language and education.

<p>Odds ratios (OR) shown compare quiz results of those quizzes taken in English to those quizzes taken in Setswana and compare participants who had greater than primary education to those who had either only primary education or no formal education.</p>1<p>Only participants with a score, language, and level of education included; participants with a level of education coded as “other” not included.</p

Odds of answering comprehension quiz questions 1–20 correctly at Quizzes 2–5 compared to enrollment quiz.

<p>Odds of answering comprehension quiz questions 1–20 correctly at Quizzes 2–5 compared to enrollment quiz.</p

Higher-than-expected prevalence of non-tuberculous mycobacteria in HIV setting in Botswana: Implications for diagnostic algorithms using Xpert MTB/RIF assay

<div><p>Background</p><p>Non-tuberculous mycobacteria (NTM) can cause pulmonary infection and disease especially among people living with HIV (PLHIV). PLHIV with NTM disease may clinically present with one of the four symptoms consistent with tuberculosis (TB). We describe the prevalence of NTM and <i>Mycobacterium tuberculosis complex</i> (MTBC) isolated among PLHIV who presented for HIV care and treatment.</p><p>Methods</p><p>All PLHIV patients presenting for HIV care and treatment services at 22 clinical sites in Botswana were offered screening for TB and were recruited. Patients who had ≥1 TB symptom were asked to submit sputa for Xpert MTB/RIF and culture. Culture growth was identified as NTM and MTBC using the SD-Bioline TB Ag MPT64 Kit and Ziehl Neelsen microscopy. NTM and MTBC isolates underwent species identification by the Hain GenoType CM and AS line probe assays.</p><p>Results</p><p>Among 16, 259 PLHIV enrolled 3068 screened positive for at least one TB symptom. Of these, 1940 submitted ≥1 sputum specimen, 427 (22%) patients had ≥1 positive-culture result identified phenotypically for mycobacterial growth. Of these 247 and 180 patients were identified as having isolates were NTM and MTBC, respectively. Of the 247 patients identified with isolates containing NTM; 19 were later excluded as not having NTM based on additional genotypic testing. Among the remaining 408 patients 228 (56%, 95% confidence interval, 46–66%) with NTM. <i>M</i>. <i>intracellulare</i> was the most common isolated (47.8%). Other NTMs commonly associated with pulmonary disease included <i>M</i>. <i>malmoense</i> (3.9%), <i>M</i>. <i>avium</i> (2.2%), <i>M</i>. <i>abscessus</i> (0.9%) and <i>M</i>. <i>kansasii</i> (0.4%). After excluding NTM isolates that were non-speciated and <i>M</i>. <i>gordonae</i> 154 (67.5%) of the NTM isolates were potential pathogens.</p><p>Conclusions</p><p>In the setting of HIV care and treatment, over-half (56%) of a positive sputum culture among PLHIV with TB symptoms was NTM. Though we were not able to distinguish in our study NTM disease and colonization, the study suggests culture and species identification for PLHIV presenting with TB symptoms remains important to facilitate NTM diagnosis and hasten time to appropriate treatment.</p></div

NTM isolated among PLHIV presenting with TB symptoms in Botswana and corresponding Xpert MTB/RIF result.

<p>NTM isolated among PLHIV presenting with TB symptoms in Botswana and corresponding Xpert MTB/RIF result.</p

Characteristics of patients with positive-culture for NTM and MTBC in a multilevel logistic regression model.

<p>Characteristics of patients with positive-culture for NTM and MTBC in a multilevel logistic regression model.</p

“Patients with at least one sputum culture results by mycobacterium species August 2012 –November 2014” Notes: * Of the total 16, 259, the 6041 were enrolled prospectively and the 10, 218 retrospectively; ** only 10, 213 were screened for TB symptoms due to amendment on main study (XPRES) data collection procedure; *** of the 3068 screened positive for TB symptom, 2296 were among prospective and 772 from retrospective cohort.

<p>“Patients with at least one sputum culture results by mycobacterium species August 2012 –November 2014” Notes: * Of the total 16, 259, the 6041 were enrolled prospectively and the 10, 218 retrospectively; ** only 10, 213 were screened for TB symptoms due to amendment on main study (XPRES) data collection procedure; *** of the 3068 screened positive for TB symptom, 2296 were among prospective and 772 from retrospective cohort.</p

Type of unsuccessful tests by Xpert testing sites.

<p>Type of unsuccessful tests by Xpert testing sites.</p