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Tuberculosis Epidemiologic Studies Consortium (TBESC)
Task Order 4: Models for incorporating HIV counseling, testing,
and referral into TB contact investigations
Task Order 4 examined a model for incorporating HIV Counseling,
Testing, and Referral (CTR) into TB Contact Investigations. This
project targeted all close contacts identified by infectious TB
patients in Manhattan from December 2002 through November 2003, and
compared outputs and outcomes in the 2 years prior to project
activities with those after implementation of project activities.
Sites
New York City Department of Health and Mental Hygiene
Study Objectives
- Increase HIV Counseling, Testing, and Referral of close
contacts to infectious TB patients
- Increase provider knowledge of HIV serostatus among close
contacts
- Screen all HIV-infected contacts for active TB and for LTBI
- Prevent progression to active TB among HIV-infected contacts
through LTBI treatment
- Prevent additional AIDS opportunistic infections among
persons living with HIV through provision of referrals to care
for HIV.
Study Design
All patients with verified tuberculosis disease that was more
likely to be infectious (sputum that is acid-fast-bacilli (AFB)
smear-positive, culture-positive for M. tuberculosis from a
pulmonary or laryngeal source, or culture-negative but with cavitary
chest radiograph) in Manhattan, NYC from December 2002 through
November 2003 were interviewed and contacts were elicited. This
project collected data prospectively from the one-year cohort of
elicited close contacts to infectious TB patients for whom HIV
counseling, testing, and referral services were systematically
incorporated into contact investigation procedures. This project
design enabled the effectiveness of the project to be evaluated by
comparing post-project results to pre-project data.
Study Progress
The study has been completed. Final enrollment was 614 close
contacts to 205 infectious TB patients. Of 614 contacts, 569 (93%)
were provided HIV information and offered HIV CTR. Of the 569, 29%
were newly tested, 10% were previously HIV-tested (with 24 found to
be HIV-infected), and 61% were not tested for HIV. Newly HIV-tested
contacts (vs. not tested) were more likely to be aged 18-24,
Hispanic, or non-Hispanic black. Of 18 eligible HIV-infected
contacts, 56% started and half completed treatment for latent TB
infection. It cost $1 per patient to provide HIV information, $5-$8
to offer HIV CTR, and averaged $18 per contact in variable costs for
all HIV CTR efforts. Data collection was finalized in February 2004.
Analyses included a comparison of newly HIV-tested and previously
HIV-tested to not-tested contacts, an assessment of factors
associated with acceptance of testing, a description of TB outcomes,
and an estimate of project costs. The project increased HIV
counseling and testing of high risk groups and improved TB screening
of those found to be HIV-infected. Provider knowledge of HIV status
increased from 2% in 2000 to 39% during the project, an increase of
almost 20-fold. Currently, the Translating Research into Practice (TRiP)
workgroup is working with Task Order 4 and making recommendations on
how to disseminate these results, so that they are implemented into
TB control practices.
Last Modified: 07/25/2007
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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