Opportunities for Tuberculosis Diagnosis and Prevention among Persons Living with HIV: A Cross-Sectional Study of Policies and Practices at Four Large Ryan White Program-Funded HIV Clinics

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Pascopella, Lisa ; Franks, Julie ; Marks, Suzanne M. ; Salcedo, Katya ; Schmitz, Kjersti ; Colson, Paul W. ; Hirsch-Moverman, Yael ; Flood, Jennifer ; Sayles, Jennifer
• Description:
  Objective
  
  We describe the frequency and attributes of tuberculosis testing and treatment at four publicly-funded HIV clinics.
  
  Methods
  
  We abstracted medical records from a random sample of 600 HIV-infected patients having at least one clinic visit in 2009 at four clinics in New York and Los Angeles Metropolitan Statistical areas. We described testing and treatment for tuberculosis infection (TBI), 2008–2010, and estimated adjusted odds ratios (aORs). We interviewed key informants and described clinic policies and practices.
  
  Results
  
  Of 600 patients, 500 were eligible for testing, and 393 (79%) were tested 2008–2010; 107 (21%) did not receive at least one tuberculin skin test or interferon gamma release assay. Results were positive in 20 (5%) patients, negative in 357 (91%), and unknown in 16 (4%). Fourteen (70%) of 20 patients with TBI initiated treatment at the clinics; only three were documented to have completed treatment. Three hundred twenty three (54%) patients had chest radiography, 346 (58%) had tuberculosis symptom screening, and three had tuberculosis disease (117 per 100,000 person-years, 95% confidence interval (CI) = 101–165). Adjusting for site, non-Hispanic ethnicity (aOR = 4.9, 95% CI = 2.6–9.5), and employment (aOR = 1.9, 95% CI = 1.0–3.4) were associated with TBI testing; female gender (aOR = 2.0, 95% CI = 1.4–3.3), non-black race (aOR = 1.7, 95% CI = 1.3–2.5), and unemployment (aOR = 1.5, 95% CI = 1.1–2.1) were associated with chest radiography. Clinics evaluated TBI testing performance annually and identified challenges to TB prevention.
  
  Conclusions
  
  Study clinics routinely tested patients for TBI, but did not always document treatment. In a population with a high TB rate, ensuring treatment of TBI may enhance TB prevention.
  
  
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Ambulatory Care Facilities Antiretroviral Therapy, Highly Active Cross-Sectional Studies Female HIV Infections Humans Male Middle Aged Policy Radiography, Thoracic Tuberculosis Young Adult

  More +
• Source:
  PLoS One. 2014; 9(7).
• Document Type:
  Journal Article
• Volume:
  9
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:903b6f3da1a8d6bf72df9a29d6a811cc4afeda8260d8917d6ac62f62c591c19d
• Download URL:
  https://stacks.cdc.gov/view/cdc/26791/cdc_26791_DS1.pdf
• File Type:
  [PDF - 207.61 KB ]