Sackoff J E, Torian L V, Frieden T R, Brudney K F, Menzies I B
New York City Department of Health, Office of AIDS Research, New York 10013, USA.
AIDS. 1998 Oct 22;12(15):2017-23. doi: 10.1097/00002030-199815000-00013.
To determine whether Centers for Disease Control and Prevention recommendations for purified protein derivative (PPD) testing and tuberculosis (TB) preventive therapy for PPD-positive patients are implemented in HIV clinics.
Retrospective medical chart review.
Ten hospital-based HIV clinics in New York City.
A total of 2397 patients with a first clinic visit in 1995.
PPD testing of eligible patients, and recommendation of preventive therapy and completion of regimen in PPD-positive patients.
Outpatient medical records were abstracted for TB history, PPD testing, TB preventive therapy, and patient demographic, social and clinical characteristics. Multivariate analyses were performed using logistic regression.
Of 1342 patients with an indication for a PPD test, 865 (64%) were PPD tested in the clinic and 757 (88%) returned to have it read. Factors strongly associated with PPD testing in the clinic were number of visits, same sex behavior with men, and CD4+ lymphocyte count above 200 x 10(6)/l. Preventive therapy was recommended for 80% of newly identified PPD-positive patients and 22% of previously identified PPD-positive patients. Of 119 patients on preventive therapy in the clinic, 49 (41%) completed the regimen, 50 (42%) were lost to follow-up, and 20 (17%) discontinued therapy or their status could not be determined.
A significant number of missed opportunities to implement TB prevention practices were identified in HIV clinics. Focused attention in HIV clinics, and increased collaboration between HIV clinics and TB control programs may be needed to increase adherence to prevention guidelines.
确定疾病控制与预防中心针对结核菌素纯蛋白衍生物（PPD）检测及PPD阳性患者的结核病（TB）预防性治疗的建议在艾滋病诊所是否得到执行。
回顾性病历审查。
纽约市的十家医院艾滋病诊所。
1995年首次到诊所就诊的2397名患者。
符合条件患者的PPD检测、预防性治疗建议以及PPD阳性患者治疗方案的完成情况。
提取门诊病历中的结核病病史、PPD检测、结核病预防性治疗以及患者的人口统计学、社会和临床特征信息。采用逻辑回归进行多变量分析。
在1342名有PPD检测指征的患者中，865名（64%）在诊所接受了PPD检测，757名（88%）返回诊所读取检测结果。与在诊所进行PPD检测密切相关的因素包括就诊次数、与男性的同性性行为以及CD4 +淋巴细胞计数高于200×10⁶/L。80%新确诊的PPD阳性患者和22%既往确诊的PPD阳性患者被建议接受预防性治疗。在诊所接受预防性治疗的119名患者中，49名（41%）完成了治疗方案，50名（42%）失访，20名（17%）中断治疗或其状态无法确定。
在艾滋病诊所发现了大量未实施结核病预防措施的错失机会。可能需要在艾滋病诊所给予重点关注，并加强艾滋病诊所与结核病控制项目之间的合作，以提高对预防指南的依从性。
