Low adherence to guidelines for preventing TB among persons with newly diagnosed HIV infection, United States.
METHODS
Persons infected with human immunodeficiency virus (HIV) are at risk for developing tuberculosis (TB) if latent TB infection remains untreated.


OBJECTIVE
To assess missed opportunities for preventing TB by selecting a population-based sample of 1093 persons diagnosed with HIV from June 1995 to June 1997 in Seattle, WA, New Orleans, LA, and Jersey City, NJ.


METHODS
To determine the proportion of persons receiving a tuberculin skin test (TST) following HIV diagnosis, we conducted record reviews at providers and local TB control.


RESULTS
An estimated 53.7% (95% CI 49.9-57.4) had a TST following HIV diagnosis; 6.6% (95% CI 4.3-8.9%) of TST-tested patients were reactive. Median time between HIV diagnosis and TST was 1 month (mean 5.7 months, 95% CI 4.8-6.5). Factors associated with TST included additional risk factors for TB (OR 1.76, 95% CI 1.17-2.63), history of HIV-related preventive treatment (OR 5.84, 95% CI 3.74-8.75), higher number of clinic visits (OR 4.16, 95% CI 2.01-8.02), and attendance at facilities with a written policy to provide TST for all persons with HIV (OR 2.54, 95% CI 1.28-4.88).


CONCLUSIONS
About half of persons newly diagnosed with HIV infection had a TST following HIV diagnosis, with little variation by demographics, signaling a general need to improve interventions to prevent TB.
Lee
L M
LM
Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. LMLee@cdc.gov
Lobato
M N
MN
Buskin
S E
SE
Morse
A
A
Costa
O S
OS
D005260:Female; D019983:Guideline Adherence; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology