title: Opportunities for tuberculosis diagnosis and prevention among persons living with HIV: a cross-sectional study of policies and practices at four large Ryan White Program-Funded HIV clinics.
abstract: OBJECTIVE
  We describe the frequency and attributes of tuberculosis testing and treatment at four publicly-funded HIV clinics.
  
  
  METHODS
  We abstracted medical records from a random sample of 600 HIV-infected patients having at least one clinic visit in 2009 at four clinics in New York and Los Angeles Metropolitan Statistical areas. We described testing and treatment for tuberculosis infection (TBI), 2008-2010, and estimated adjusted odds ratios (aORs). We interviewed key informants and described clinic policies and practices.
  
  
  RESULTS
  Of 600 patients, 500 were eligible for testing, and 393 (79%) were tested 2008-2010; 107 (21%) did not receive at least one tuberculin skin test or interferon gamma release assay. Results were positive in 20 (5%) patients, negative in 357 (91%), and unknown in 16 (4%). Fourteen (70%) of 20 patients with TBI initiated treatment at the clinics; only three were documented to have completed treatment. Three hundred twenty three (54%) patients had chest radiography, 346 (58%) had tuberculosis symptom screening, and three had tuberculosis disease (117 per 100,000 person-years, 95% confidence interval (CI) = 101-165). Adjusting for site, non-Hispanic ethnicity (aOR = 4.9, 95% CI = 2.6-9.5), and employment (aOR = 1.9, 95% CI = 1.0-3.4) were associated with TBI testing; female gender (aOR = 2.0, 95% CI = 1.4-3.3), non-black race (aOR = 1.7, 95% CI = 1.3-2.5), and unemployment (aOR = 1.5, 95% CI = 1.1-2.1) were associated with chest radiography. Clinics evaluated TBI testing performance annually and identified challenges to TB prevention.
  
  
  CONCLUSIONS
  Study clinics routinely tested patients for TBI, but did not always document treatment. In a population with a high TB rate, ensuring treatment of TBI may enhance TB prevention.
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America.
authors.forename: Lisa
authors.initials: L
authors.lastname: Pascopella
authors.affiliation: The International Center for AIDS Care and Treatment Programs (ICAP)/Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Julie
authors.initials: J
authors.lastname: Franks
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Marks
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America.
authors.forename: Katya
authors.initials: K
authors.lastname: Salcedo
authors.affiliation: The International Center for AIDS Care and Treatment Programs (ICAP)/Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Schmitz
authors.affiliation: The International Center for AIDS Care and Treatment Programs (ICAP)/Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Colson
authors.affiliation: The International Center for AIDS Care and Treatment Programs (ICAP)/Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Yael
authors.initials: Y
authors.lastname: Hirsch-Moverman
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Flood
authors.affiliation: Office of AIDS Programs and Policy, Los Angeles County Department of Public Health, Los Angeles, California, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sayles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000191:economics*; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D057766:Policy; D013902:Radiography, Thoracic; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000517:prevention & control*; D055815:Young Adult