Timely HIV Diagnosis and HIV/TB Comanagement among California Patients in 2008

Abstract

Objective. National guidelines highlight the roles of early HIV diagnosis and effective comanagement for HIV and tuberculosis (TB) to prevent mortality and morbidity from HIV-related TB. We assessed HIV diagnosis timing and HIV/TB comanagement for California HIV/TB patients.Methods. We reviewed and analyzed public health charts for California HIV/TB patients reported during 2008. HIV diagnoses fewer than three months before TB diagnosis were considered new HIV diagnoses. We determined the proportion of patients with new HIV diagnoses, risk factors for new HIV diagnoses, and proportion of patients receiving recommended CD4 cell count measurements, supervised TB therapy, and antiretroviral therapy (ART).results. Of 130 HIV/TB patients, 51% had new HIV diagnoses. Foreign-born patients were more likely than U.S.-born patients to have new HIV diagnoses. Supervised TB therapy and CD4 cell count measurements followed national recommendations for 91% and 74% of patients, respectively. At least 73% of patients started ART before completing TB therapy. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses started ART later and had lower CD4 cell counts and higher viral loads at TB diagnosis.conclusions. Although most HIV/TB patients received the recommended treatment, half had new HIV diagnoses. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses had greater immunosuppression at TB diagnosis. A new diagnosis indicates that HIV could have been diagnosed earlier and ART or treatment for latent TB infection could have been initiated to prevent TB development.

The Role of Neighborhood Poverty in the Association between Foreign-Born status and HIV Care Continuum Outcomes in Alameda County, California

“…Along with efforts to make progress on each outcome on the "HIV care cascade", the Joint United Nations Programme on HIV/AIDS (UNAIDS) calls for making equitable progress on HIV outcomes and addressing HIV-related disparities by devising focused prevention and treatment programs for key populations [1]. One population of interest is foreignborn persons living in the US, who have an increased risk of exposure to HIV and higher rates of HIV incidence [2,3]. Previous studies comparing US-born and foreign-born persons have found that the epidemiology of HIV among foreign-born persons living in the US is complex and involves risk factors related to immigration, education, and health care.…”