CONTEXT: Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV. OBJECTIVE: We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence. DESIGN: We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV. SETTING: California TB programs. PARTICIPANTS: All TB patients reported from California in 2008. MAIN OUTCOME MEASURES: Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types. RESULTS: Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a known HIV status before TB diagnosis. Among the remaining 280 patients, 187 patients (67%) were diagnosed with TB by a private provider. CONCLUSIONS: The HIV status determination of TB patients was selective and not routine as recommended. Private providers can play a key role in testing for HIV at TB diagnosis. California TB programs should ensure that all TB patients have an HIV status by promulgating national recommendations, educating private providers on the benefits of testing TB patients for HIV, and monitoring completeness of HIV status determination.
CONTEXT: Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV. OBJECTIVE: We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence. DESIGN: We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV. SETTING: California TB programs. PARTICIPANTS: All TB patients reported from California in 2008. MAIN OUTCOME MEASURES: Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types. RESULTS: Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a known HIV status before TB diagnosis. Among the remaining 280 patients, 187 patients (67%) were diagnosed with TB by a private provider. CONCLUSIONS: The HIV status determination of TB patients was selective and not routine as recommended. Private providers can play a key role in testing for HIV at TB diagnosis. California TB programs should ensure that all TB patients have an HIV status by promulgating national recommendations, educating private providers on the benefits of testing TB patients for HIV, and monitoring completeness of HIV status determination.
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