1 Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Chicago Center for HIV Elimination, University of Chicago Department of Medicine, Chicago, IL, USA.
Public Health Rep. 2018 Jul/Aug;133(4):413-422. doi: 10.1177/0033354918776639. Epub 2018 Jun 21.
In the United States, universal screening for latent tuberculosis (TB) infection among people with HIV is recommended, but the percentage receiving screening is unknown. This study assessed screening for latent TB infection among people with HIV enrolled in Medicaid during 2006-2010.
We used nationwide fee-for-service Medicaid records to identify people with HIV, measure screening for latent TB infection, and examine associated demographic, social, and clinical factors. We used logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs). We created 2 multivariate models to prevent collinearity between variables for length of HIV infection.
Of 152 831 people with HIV, 26 239 (17.2%) were screened for latent TB infection. The factor most strongly associated with screening was TB exposure or suspected TB (OR = 3.78; 95% CI, 3.27-4.37). Significant demographic characteristics associated with screening included being African American (OR = 1.28; 95% CI, 1.24-1.32) or ≤20 years of age (OR = 1.35; 95% CI, 1.28-1.42). Significant clinical and social factors associated with screening included poor housing conditions, low body mass index, chemotherapy treatment, and use of certain substances (ORs ranged from 1.24 [95% CI, 1.20-1.27] to 1.47 [95% CI, 1.22-1.76]). The screening rate for latent TB infection was higher among people with newly diagnosed HIV infection than among those with established infection (OR = 1.37; 95% CI, 1.32-1.41) and among people with a longer established HIV infection than among those with shorter HIV infection (OR = 1.24; 95% CI, 1.23-1.26 for each additional year).
Screening for latent TB infection among fee-for-service Medicaid beneficiaries with HIV was suboptimal, despite the presence of demographic, social, or clinical characteristics that should have increased the likelihood of screening. The lack of certain data in Medicaid may have resulted in an underestimation of screening.
在美国，建议对艾滋病毒感染者进行潜伏性结核病（TB）感染的普遍筛查，但接受筛查的比例尚不清楚。本研究评估了 2006-2010 年期间参加医疗补助计划（Medicaid）的艾滋病毒感染者的潜伏性 TB 感染筛查情况。
我们利用全国范围内的按服务收费的医疗补助记录，确定艾滋病毒感染者，测量潜伏性 TB 感染筛查情况，并检查相关的人口统计学、社会和临床因素。我们使用逻辑回归分析计算比值比（OR）和 95%置信区间（CI）。我们创建了 2 个多变量模型，以防止 HIV 感染时间变量之间的共线性。
在 152831 名艾滋病毒感染者中，有 26239 人（17.2%）接受了潜伏性 TB 感染筛查。与筛查最密切相关的因素是结核病暴露或疑似结核病（OR=3.78；95%CI，3.27-4.37）。与筛查显著相关的显著人口统计学特征包括非裔美国人（OR=1.28；95%CI，1.24-1.32）或年龄≤20 岁（OR=1.35；95%CI，1.28-1.42）。与筛查显著相关的临床和社会因素包括住房条件差、低体重指数、化疗治疗以及使用某些物质（比值比范围为 1.24[95%CI，1.20-1.27]至 1.47[95%CI，1.22-1.76]）。与新诊断的 HIV 感染者相比，已确诊的 HIV 感染者（OR=1.37；95%CI，1.32-1.41）和 HIV 感染时间较长的感染者（OR=1.24；95%CI，1.23-1.26，每增加 1 年）接受潜伏性 TB 感染筛查的可能性更高。
尽管存在应增加筛查可能性的人口统计学、社会或临床特征，但按服务收费的医疗补助受益人的 HIV 感染者潜伏性 TB 感染筛查情况并不理想。医疗补助中某些数据的缺失可能导致筛查率被低估。
