Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Robert D. Bruce

Subject Area(s)

Public health


CASE FINDING FOR PULMONARY TUBERCULOSIS AMONG PEOPLE WHO INJECT DRUGS IN DAR ES SALAAM, TANZANIA. Akash Gupta. Jessie Mbwambo. Ibrahim Mteza. Sheela Shenoi. Barrott Lambdin. Cassian Nyandindi. Basra Ismail Doula, Said Mfaume, and Robert Douglas Bruce. Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

Active case finding is a World Health Organization (WHO)-endorsed strategy for improving case detection of tuberculosis. Despite WHO recommendations for active case finding among people who inject drugs (PWID), there are few published studies. The historical focus of case finding has been in populations that are HIV-positive, incarcerated, or at higher occupational risk. We sought to examine the yield of active case finding among PWID newly started on methadone in Tanzania.

A questionnaire including tuberculosis symptoms and risk factors was administered to every consenting patient by a native Swahili-speaker. Additional chart review was performed for demographic information and HIV status. Two sputum samples were collected for every symptomatic patient, and samples were tested using smear microscopy as well as culture.

A total of 156 of 222 (70%) methadone clients met with study administrators; 150 of whom consented to the study. Median age was 34 years old, and 139 (93%) were male. Thirty-four (23%) were HIV-positive, and an additional 104 (69%) had an unknown HIV status. Of the 150 patients surveyed, 16 (11%) had one or more tuberculosis symptoms and were referred for laboratory testing. Six new cases of tuberculosis were identified, 5 of which were sputum smear-negative, and 1 of which was multi-drug resistant. The prevalence of tuberculosis was 4%

This study presents the first data on tuberculosis prevalence in a population of PWID in Tanzania. This prevalence is 23 times the general Tanzanian tuberculosis prevalence of 0.2%. PWID in Tanzania should continue to be screened for tuberculosis with smear, culture and drug susceptibility testing. Screening should expand to PWID in the community.