Tuberculosis Control Branch, California Department of Public Health, Richmond, CA 94804, USA.
J Public Health Manag Pract. 2013 Mar-Apr;19(2):169-77. doi: 10.1097/PHH.0b013e3182550a83.
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.
We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence.
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.
California TB programs.
All TB patients reported from California in 2008.
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.
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 known HIV status before TB diagnosis. Among the remaining 280 patients, 187 patients (67%) were diagnosed with TB by a private provider.
The HIV status determination of TB patients was selective and not routine as recommended. Private providers can play a key role in testing for HIV at TB diagnosis. California TB programs should ensure that all TB patients have an HIV status by promulgating national recommendations, educating private providers on the benefits of testing TB patients for HIV, and monitoring completeness of HIV status determination.
人类免疫缺陷病毒（HIV）感染使结核病（TB）患者的治疗复杂化，并导致较差的治疗结局。美国疾病控制与预防中心建议所有 TB 患者都接受 HIV 检测。
评估 TB 患者 HIV 状态确定的完整性，并确定在遵守建议方面的关键差距。
我们对公共卫生记录进行了回顾性审查，以确定 2008 年加利福尼亚州报告的所有 TB 患者的 HIV 状态。然后，我们使用逻辑回归来确定与已知（阳性或阴性）HIV 状态相关的因素。选择了 TB 患者的随机样本进行二次审查，以描述 HIV 状态确定的时间以及有机会进行 HIV 检测的提供者。
加利福尼亚州 TB 项目。
2008 年加利福尼亚州报告的所有 TB 患者。
具有已知 HIV 状态的患者比例、具有已知 HIV 状态的患者的调整优势比、在 TB 诊断之前具有已知 HIV 状态的患者比例以及由不同提供者类型诊断为 TB 的患者比例。
在 2667 例 TB 患者中，仅有 1752 例（66%）具有已知 HIV 状态。具有已知 HIV 状态与年龄在 15 至 44 岁之间以及使用任何公共提供者参与治疗密切相关。在随机样本的 292 例患者中，有 12 例（4%）在 TB 诊断之前具有已知 HIV 状态。在其余 280 例患者中，有 187 例（67%）由私人提供者诊断为 TB。
TB 患者的 HIV 状态确定具有选择性，不符合推荐的常规做法。私人提供者在 TB 诊断时可以在 HIV 检测中发挥关键作用。加利福尼亚州 TB 项目应通过颁布国家建议、教育私人提供者检测 TB 患者 HIV 的益处以及监测 HIV 状态确定的完整性，确保所有 TB 患者都具有 HIV 状态。
