HIV Status Determination Among Tuberculosis Patients From California During 2008
ABSTRACT : Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV.
: We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence.
: We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV.
: California TB programs.
: All TB patients reported from California in 2008.
: Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types.
: Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a known HIV status before TB diagnosis. Among the remaining 280 patients, 187 patients (67%) were diagnosed with TB by a private provider.
: The HIV status determination of TB patients was selective and not routine as recommended. Private providers can play a key role in testing for HIV at TB diagnosis. California TB programs should ensure that all TB patients have an HIV status by promulgating national recommendations, educating private providers on the benefits of testing TB patients for HIV, and monitoring completeness of HIV status determination.
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ABSTRACT: To understand the epidemiology of tuberculosis (TB) and HIV co-infection in California, we cross-matched incident TB cases reported to state surveillance systems during 1993–2008 with cases in the state HIV/AIDS registry. Of 57,527 TB case-patients, 3,904 (7%) had known HIV infection. TB rates for persons with HIV declined from 437 to 126 cases/100,000 persons during 1993–2008; rates were highest for Hispanics (225/100,000) and Blacks (148/100,000). Patients co-infected with TB–HIV during 2001–2008 were significantly more likely than those infected before highly active antiretroviral therapy became available to be foreign born, Hispanic, or Asian/Pacific Islander and to have pyrazinamide-monoresistant TB. Death rates decreased after highly active antiretroviral therapy became available but remained twice that for TB patients without HIV infection and higher for women. In California, HIV-associated TB has concentrated among persons from low- and middle-income countries who often acquire HIV infection in the peri-immigration period.Emerging Infectious Diseases 03/2013; 19(3):400-6. DOI:10.3201/eid1903.121521 · 7.33 Impact Factor
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ABSTRACT: Thirty percent of tuberculosis (TB) patients in New York City in 2007 were not tested for HIV, which may be attributable to differential testing behaviors between private and public TB providers. Adult TB cases in New York City from 2001 to 2007 (n = 5,172) were evaluated for an association between TB provider type (private or public) and HIV testing. Outcomes examined were offers of HIV tests and patient refusal of HIV testing, using multivariate logistic and binomial regression, respectively. HIV test offers were less frequent among patients who visited only private providers than patients who visited only public providers [males: adjusted odds ratio (aOR) 0.33, 95 % confidence interval (CI) 0.15-0.74; females: aOR 0.26, 95 % CI 0.12-0.57]. Changing from private to public providers was associated with an increase in HIV tests offered among male patients (aOR 1.96, 95 % CI 1.04-3.70). Among patients who did not use substances, those who visited only private providers were more likely to refuse HIV testing than those who visited only public providers [males: adjusted prevalence ratio (aPR) 1.26, 95 % CI 0.99-1.60; females: aPR 1.78, 95 % CI 1.43-2.22]. Patients of private providers were less likely to have an HIV test performed during their TB treatment. Education of TB providers should emphasize HIV testing of all TB patients, especially among patients who are traditionally considered low-risk.Journal of Community Health 10/2013; 39(3). DOI:10.1007/s10900-013-9783-9 · 1.28 Impact Factor
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ABSTRACT: Collaborative TB/HIV management is essential to ensure that HIV positive TB patients are identified and treated appropriately, and to prevent tuberculosis (TB) in HIV positive patients. The purpose of this study was to assess HIV case finding among TB patients and Co-trimoxazole Preventive Therapy (CPT) for HIV/TB patients in Addis Ababa. A descriptive cross-sectional, facility-based survey was conducted between June and July 2011. Data was collected by interviewing 834 TB patients from ten health facilities in Addis Ababa. Both descriptive and inferential statistics were used to summarize and analyze findings. The proportion of TB patients who (self reported) were offered for HIV test, tested for HIV and tested HIV positive during their anti-TB treatment follow-up were; 87.4%, 69.4% and 20.2%; respectively. Eighty seven HIV positive patients were identified, who knew their status before diagnosed for the current TB disease, bringing the cumulative prevalence of HIV among TB patients to 24.5%. Hence, the proportion of TB patients who knew their HIV status becomes 79.9%. The study revealed that 43.6% of those newly identified HIV positives during anti-TB treatment follow-up were actually treated with CPT. However, the commutative proportion of HIV positive TB patients who were ever treated with CPT was 54.4%; both those treated before the current TB disease and during anti-TB treatment follow-up. HIV case finding among TB patients and provision of CPT for TB/HIV co-infected patients needs boosting. Hence, routine offering of HIV test and provision of CPT for PLHIV should be strengthened in-line with the national guidelines.PLoS ONE 02/2014; 9(2):e86614. DOI:10.1371/journal.pone.0086614 · 3.53 Impact Factor