Background:  HIV and TB are the leading infectious causes of death among women of reproductive age worldwide. TB is a significant cause of maternal and infant morbidity and mortality. The Perinatal HIV Research Unit provides counseling and testing for HIV and prevention of mother-to-child transmission (PMTCT) regimens through 13 government-run antenatal clinics in Soweto, South Africa. We hypothesized that integrating PMTCT services and provider-initiated screening for TB among pregnant women would be a high yield intervention for detection of active pulmonary TB.

Methods:  This was a cross-sectional study performed in 6 antenatal clinics in Soweto, including the antenatal clinic at Chris Hani Baragwanath Hospital. The study population included all pregnant women 18 years of age and older presenting to the clinics and who verbally consented to participate. Women presenting with obstetric complications or medical emergencies, women who declined or were unable to provide verbal consent, and prisoners were excluded from the study. All study participants, regardless of their HIV status, were screened for symptoms of active pulmonary TB: cough for ≥2 weeks, sputum production, fevers, night sweats, or weight loss. Information on study participant demographics, HIV status, CD4⁺ T cell count, and prior TB and HIV history was collected. All study participants with any symptom of active TB were asked to cough up a single sputum specimen, which was then sent for sputum smear microscopy, mycobacterial culture and identification, and first line drug-susceptibility testing.

Results:  We enrolled 3970 pregnant women between December 2008 and August 2009. Their ages ranged from 18 to 49 years (median 26). Of women enrolled, 36%were HIV-infected, among whom 2% had a CD4⁺ T cell count of 0 to 50, 17% of 51 to 200, 30% of 201 to 350, 22% of 351 to 500, 19% of >500, and 9% unknown; 5% of women had a prior history of TB disease, and 21% had a history of exposure to someone with active pulmonary TB. The prevalence of active pulmonary TB was 696/100,000 among HIV-infected pregnant women (10 cases), and 200/100,000 among HIV-uninfected pregnant women (5 cases).

Conclusions:  Provider-initiated TB screening among HIV-infected pregnant women is a high yield intervention, and should be integrated with PMTCT services. Given that 49% of the women had CD4⁺ T cell counts ≤350, both ART and isoniazid preventive therapy should be considered.