HIV Status Determination Among Tuberculosis Patients From California During 2008

Abstract

Context-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.Objective-We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence.Design-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. Setting-California TB programs. Participants-All TB patients reported from California in 2008.Main Outcome Measures-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.Results-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 This also presents a gap in TB management and public health TB control. Human immunodeficiency virus infection is a risk factor for death with TB, 5-9 TB recurrence, 10 and acquired TB drug resistance with intermittent therapy. 11-13 Thus, HIV status determination is needed to identify TB patients who should receive daily directly observed TB therapy and highly active antiretroviral therapy to prevent poor TB outcomes. 14-17 Human immunodeficiency virus status determination is also needed for TB programs to link HIVinfected TB patients to HIV care services and to identify HIV-infected contacts, who are at increased risk for progression to disease. 18 Ensuring complete HIV status determination among patients is part of TB programs' broader responsibility to monitor and ensure the quality of all TB-related activities. However, the decision to test patients for HIV ultimately rests with the provider. Although TB programs can directly implement routine HIV testing for patients in public TB clinics, they have less influence over the care given by private providers. Therefore, public health efforts to ensure complete HIV status determination must consider the provider types involved in TB care and target interventions appropriately. HHS Public AccessWe conducted an evaluation of TB patients reported from California in 2008 to (1) assess completeness of HIV status determination, (2) identify factors associated with having a known HIV status, (3) characterize providers who have opportunity to test for HIV during TB care, and (4) provide recommendations to increase HIV status determination completeness. Me...

Tuberculosis Treatment Managed by Providers outside the Public Health Department: Lessons for the Affordable Care Act

“…Our findings are consistent with evidence showing that patients in public health TB clinics are more likely to receive care recommended in TB control guidelines. [25] – [31] Similar findings have been published in which clinicians and clinics with the most experience and volume provide care resulting in better outcomes to patients for other diagnoses such as HIV [32] and Staphylococcus aureus bacteremia. [33] – [35] The results also highlight the concept that public health TB clinics and programs warrant consideration as expert, specialty referral clinics, and not simply government sector safety net providers.…”

HIV Testing of Tuberculosis Patients by Public and Private Providers in New York City

“…[7] Although the type of TB medical provider (public vs. private) has been implicated in the failure to adhere to other clinical guidelines for the diagnosis and treatment of TB, the potential association between a patient’s provider type and specific poor HIV testing outcomes (failure of a provider to offer a test, patient refusal of a test) has not been examined in the ART era. [14–17, 21] This study framed the issue of HIV testing and TB providers within the high TB and HIV incidence area of NYC, focusing on the ART era (2001–2007).…”

“…[11] Recent data exploring the relationship between the type of TB medical provider and adherence to HIV testing recommendations are predominately descriptive and did not differentiate a provider’s failure to offer an HIV test and a patient’s test refusal. [21]…”

A systematic synthesis of direct costs to treat and manage tuberculosis disease applied to California, 2015

“…The results of our review suggest a need for updated estimates of the costs of TB hospitalization because TB hospitalization practices may have changed since then. A study of human immunodeficiency virus (HIV) testing of TB case patients in California in 2008 suggested that as few as one-third of TB patients were hospitalized [ 9 ], compared to one half of patients in the mid-1990s [ 10 ]. On the other hand, a study of 135 MDR TB patients in the US during 2005–2007 demonstrated longer times in the hospital, and increased drug resistance, which cost more, compared to study cohorts from a 1996 study [ 11 ].…”