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The Impact of HIV Infection on TB disparities among U.S.-born Black and White Tuberculosis Patients in the United States
  • Published Date:
    February 14 2019
  • Source:
    J Public Health Manag Pract.
  • Language:
    English


Public Access Version Available on: August 14, 2020 information icon
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Details:
  • Pubmed ID:
    30789591
  • Pubmed Central ID:
    PMC6693994
  • Description:
    Background/Objectives

    U.S.-born non-Hispanic black (blacks) persons (12% of U.S. population) accounted for 41% of HIV diagnoses during 2008–2014. HIV significantly increases TB and TB-related mortality. TB rate ratios were 6–7 times as high in blacks versus U.S.-born non-Hispanic whites (whites) during 2013–2016. We analyzed a sample of black and white TB patients to assess the impact of HIV on TB racial disparities.

    Methods

    552 black and white TB patients with known HIV status were recruited from 10 U.S. sites in 2009–2010. We abstracted data from the National TB Surveillance System, medical records, and death certificates, and interviewed 477 patients. We estimated adjusted odds ratios (AOR) with 95% confidence intervals (CI) for associations of with HIV infection, late HIV diagnosis (≤ 3 months before or any time after TB diagnosis), and mortality during TB treatment.

    Results

    Twenty-one percent of the sample had HIV. Blacks (AOR=3.4, CI=1.7–6.8), and persons with recent homelessness (AOR=2.5, CI=1.5–4.3) had greater odds of HIV than others. The majority of HIV/TB patients were diagnosed with HIV ≤ 3 months before (57%) or after (4%) TB diagnosis. Among HIV/TB patients, blacks had similar percentages to whites (61% versus 57%) of late HIV diagnosis. Twenty-five percent of HIV/TB patients died, 38% prior to TB diagnosis and 62% during TB treatment. Blacks did not have significantly greater odds of TB-related mortality than whites (AOR=1.1, CI=.6–2.1).

    Conclusions

    Black TB patients had greater HIV prevalence than whites. While mortality was associated with HIV, it was not significantly associated with black or white race.

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