Low adherence to guidelines for preventing TB among persons with newly diagnosed HIV infection, United States
Abstract:SETTING: Persons infected with human immunodeficiency virus (HIV) are at risk for developing tuberculosis (TB) if latent TB infection remains untreated.
OBJECTIVE: To assess missed opportunities for preventing TB by selecting a population-based sample of 1093 persons diagnosed with HIV from June 1995 to June 1997 in Seattle, WA, New Orleans, LA, and Jersey City, NJ.
DESIGN: To determine the proportion of persons receiving a tuberculin skin test (TST) following HIV diagnosis, we conducted record reviews at providers and local TB control.
RESULTS: An estimated 53.7% (95%CI 49.9–57.4) had a TST following HIV diagnosis; 6.6% (95%CI 4.3–8.9%) of TST-tested patients were reactive. Median time between HIV diagnosis and TST was 1 month (mean 5.7 months, 95%CI 4.8–6.5). Factors associated with TST included additional risk factors for TB (OR 1.76, 95%CI 1.17–2.63), history of HIV-related preventive treatment (OR 5.84, 95%CI 3.74–8.75), higher number of clinic visits (OR 4.16, 95%CI 2.01–8.02), and attendance at facilities with a written policy to provide TST for all persons with HIV (OR 2.54, 95%CI 1.28–4.88).
CONCLUSION: About half of persons newly diagnosed with HIV infection had a TST following HIV diagnosis, with little variation by demographics, signaling a general need to improve interventions to prevent TB.
Document Type: Regular Paper
Affiliations: 1: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: Public Health—Seattle & King County, Seattle, Washington, USA 4: Health Sciences Center, Louisiana State University, New Orleans, Louisiana, USA; and Louisiana Department of Health and Hospitals, New Orleans, Louisiana, USA 5: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and New Jersey Department of Health and Senior Services, Trenton, New Jersey, USA
Publication date: February 1, 2006
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