High HIV-TB co-infection rates in marginalized populations: evidence from Alberta in support of screening TB patients for HIV.

Heretofore we have not seen strong evidence of synergy between HIV and tuberculosis (TB) in Canada. This may simply reflect a lack of concurrent surveillance for the two diseases. To date, the goal of universal HIV testing of TB patients (> 80% tested) in Canada has not been achieved, despite the existence of two national advisories recommending universal HIV testing of TB patients. In response to these advisories, we recently undertook to demonstrate the feasibility of using an 'opt-out' approach to achieve universal HIV testing of TB patients in Alberta--see the Canadian Journal of Public Health 2009;100(2):116-20. In the present commentary, we add two more years of data (2007-2008) to our earlier report and demonstrate for the first time that HIV co-infection is significantly greater in middle-aged (35-64 years) compared to young adult (15-34 years) TB patients and in Aboriginal and sub-Saharan African, compared to Canadian-born non-Aboriginal and foreign-born 'other' TB patients. Our findings underscore the need for universal concurrent testing as well as greater interaction between TB and HIV programs.