Variations in methods of diagnosis of pulmonary tuberculosis at initiation of treatment in Kiambu County between 2012 and 2016

Background: The World Health Organization’s end TB strategy recommends that over 90% of TB patients should be diagnosed based on testing. The modalities available for TB testing in Kiambu County are the X‐ray, Sputum Smear Microscopy, Cultures and GeneXpert MTB/RIF. There is minimal knowledge on the uptake of these diagnostics in actual practice in the county. Objective: To assess the variations in methods of diagnosis amongst patients at initiation of TB treatment seen in Kiambu county between 2012 and 2016 Design: A cross‐sectional study Setting: Kiambu County, Kenya Population: 11,841 patients notified into TIBU within Kiambu County Results: In the study period, there was a gradual increase in the uptake of bacteriological confirmation from 43.6% in 2014 to 58.2% in 2016. Chest X‐rays were mostly used in children (62.9%) while Sputum Smear Microscopy was used mostly in adults (69.1%). Uptake of culture was very poor with use in only 1% of adults, and no use (0%) in children in the whole study period. Use of GeneXpert MTB/RIF was also low, though there was a drastic improvement in 2016 with a 500% increase in the absolute number of tests done in comparison with 2015. Conclusion: Our study showed that there is low uptake of TB diagnostic modalities, especially amongst children, in Kiambu County. However, there was a gradual increase in their use since 2014. Further efforts are needed to increase clinician awareness and use of diagnostics.