Klein Pamela W, Harris Tiffany G, Leone Peter A, Pettifor Audrey E
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
J Community Health. 2014 Jun;39(3):494-502. doi: 10.1007/s10900-013-9783-9.
Thirty percent of tuberculosis (TB) patients in New York City in 2007 were not tested for HIV, which may be attributable to differential testing behaviors between private and public TB providers. Adult TB cases in New York City from 2001 to 2007 (n = 5,172) were evaluated for an association between TB provider type (private or public) and HIV testing. Outcomes examined were offers of HIV tests and patient refusal of HIV testing, using multivariate logistic and binomial regression, respectively. HIV test offers were less frequent among patients who visited only private providers than patients who visited only public providers [males: adjusted odds ratio (aOR) 0.33, 95% confidence interval (CI) 0.15-0.74; females: aOR 0.26, 95% CI 0.12-0.57]. Changing from private to public providers was associated with an increase in HIV tests offered among male patients (aOR 1.96, 95% CI 1.04-3.70). Among patients who did not use substances, those who visited only private providers were more likely to refuse HIV testing than those who visited only public providers [males: adjusted prevalence ratio (aPR) 1.26, 95% CI 0.99-1.60; females: aPR 1.78, 95% CI 1.43-2.22]. Patients of private providers were less likely to have an HIV test performed during their TB treatment. Education of TB providers should emphasize HIV testing of all TB patients, especially among patients who are traditionally considered low-risk.
2007年，纽约市30%的结核病患者未接受HIV检测，这可能归因于私立和公立结核病医疗机构不同的检测行为。对2001年至2007年纽约市的成年结核病病例（n = 5172）进行评估，以研究结核病医疗机构类型（私立或公立）与HIV检测之间的关联。分别使用多变量逻辑回归和二项式回归分析的结果包括HIV检测的提供情况以及患者对HIV检测的拒绝情况。仅就诊于私立医疗机构的患者接受HIV检测的频率低于仅就诊于公立医疗机构的患者[男性：调整优势比（aOR）为0.33，95%置信区间（CI）为0.15 - 0.74；女性：aOR为0.26，95%CI为0.12 - 0.57]。从私立医疗机构转至公立医疗机构与男性患者接受HIV检测的增加相关（aOR为1.96，95%CI为1.04 - 3.70）。在不使用毒品的患者中，仅就诊于私立医疗机构的患者比仅就诊于公立医疗机构的患者更有可能拒绝HIV检测[男性：调整患病率比（aPR）为1.26，95%CI为0.99 - 1.60；女性：aPR为1.78，95%CI为1.43 - 2.22]。私立医疗机构的患者在结核病治疗期间接受HIV检测的可能性较小。应对结核病医疗机构进行教育，强调对所有结核病患者进行HIV检测，尤其是对那些传统上被认为是低风险的患者。
