Naureckas Caitlin, Carter E Jane, Gardner Adrian
Warren Alpert Medical School of Brown University, Providence, Rhode Island (Ms Naureckas and Drs Carter and Gardner); and Divisions of Infectious Diseases (Drs Carter and Gardner), Pulmonary, and Critical Care Medicine (Dr Carter), The Miriam Hospital, Providence, Rhode Island.
J Public Health Manag Pract. 2015 Mar-Apr;21(2):E11-5. doi: 10.1097/PHH.0000000000000039.
Extent of and challenges to implementation of the Centers for Disease Control and Prevention (CDC) 2006 recommendation for routine HIV testing have not been reviewed specifically within tuberculosis (TB) care settings.
To determine current adherence to the CDC's HIV testing recommendations in TB care settings and identify barriers.
An online survey was designed and distributed via Survey Monkey.
The 2011 National TB Conference attendees, National TB Nurse Controllers, and the CDC's TB-educate mailing list were invited to participate via e-mail.
A total of 153 respondents from US states: 30 physicians, 91 nurses, 19 public health practitioners, and 13 other.
Perceived importance of HIV testing, current HIV testing practices, perceived barriers to HIV testing, and understanding of state HIV testing laws.
One hundred forty-one of 153 (92.2%) reported that patients with TB disease were "always" or "almost always" HIV tested; 65 of 153 (42.5%) reported the same for patients with latent TB infection (LTBI). Among those not routinely testing LTBI patients, "patient refusal of test" (53/88; 60.2%), "cost" (41/88; 46.6%), and "prevalence too low to justify" (33/88; 37.5%) were the most commonly identified barriers to opt-out testing. Forty-seven of 59 providers (79.7%) who reported that their state required written consent for HIV testing had incorrect knowledge regarding HIV testing legislation.
Rates of HIV testing are high for patients with TB disease, but fewer than half of providers' care settings routinely test LTBI patients. Knowledge of HIV status is required to appropriately interpret TST results and make decisions regarding treatment in TB infection, since HIV coinfection increases risk of progression to active TB. Lack of HIV testing in LTBI patients represents a missed opportunity to prevent TB disease and its resultant morbidity and mortality. In addition, incorrect knowledge regarding testing legislation was a common problem among our TB providers. Further work is necessary to improve HIV testing rates in patients who have not yet progressed to active TB disease.
疾病控制与预防中心（CDC）2006年关于常规HIV检测的建议在结核病（TB）护理环境中的实施程度和面临的挑战尚未得到专门审查。
确定结核病护理环境中目前对CDC HIV检测建议的遵守情况，并找出障碍。
设计了一项在线调查，并通过Survey Monkey进行分发。
通过电子邮件邀请2011年全国结核病会议的与会者、全国结核病护士管理人员以及CDC的结核病教育邮件列表中的人员参与。
来自美国各州的153名受访者：30名医生、91名护士、19名公共卫生从业者和13名其他人员。
对HIV检测重要性的认知、当前的HIV检测做法、HIV检测的感知障碍以及对州HIV检测法律的理解。
153名受访者中有141名（92.2%）报告称，结核病患者“总是”或“几乎总是”接受HIV检测；153名受访者中有65名（42.5%）对潜伏性结核感染（LTBI）患者也有同样的报告。在那些没有对LTBI患者进行常规检测的人中，“患者拒绝检测”（53/88；60.2%）、“费用”（41/88；46.6%）和“患病率过低不值得检测”（33/88；37.5%）是最常被提及的选择退出检测的障碍。在报告所在州要求HIV检测需书面同意的59名提供者中，有47名（79.7%）对HIV检测立法的了解不正确。
结核病患者的HIV检测率很高，但不到一半的提供者护理环境会对LTBI患者进行常规检测。了解HIV状况对于正确解读结核菌素皮肤试验（TST）结果以及就结核感染的治疗做出决策是必要的，因为HIV合并感染会增加进展为活动性结核病的风险。LTBI患者未进行HIV检测意味着失去了预防结核病及其所致发病率和死亡率的机会。此外，对检测立法的了解不正确是我们结核病提供者中常见的问题。有必要进一步努力提高尚未进展为活动性结核病患者的HIV检测率。
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