Abstract
Objective
ID=Universal HIV testing of tuberculosis (TB) patients, defined as testing greater than 80% of incident cases, has been recommended but not achieved in Canada. The objectives of this study were: i) to assess the success of an ‘opt-out’ approach, whereby HIV testing is routine unless the patient specifically chooses otherwise, and ii) to determine the risk factors for HIV in patients tested before and after this approach was implemented.
Methods
ID=TB and HIV databases in the province of Alberta were cross-matched before HAART (highly active anti-retroviral therapy) was available (1991-1997), after HAART but before ‘opt-out’ testing was implemented (1998-2002), and after ‘opt-out’ testing was implemented (2003–2006), and the HIV status of TB patients in each time period was described. The demographic and clinical characteristics of HIV-positive and -negative TB patients aged 15–64 years were compared.
Results
ID=HIV testing of TB patients increased from 11.5% before HAART, to 44.9% after HAART but before ‘opt-out’ testing, to 81.9% after ‘opt-out’ testing was implemented. Between 1991 and 2006, 50 TB patients were diagnosed with HIV co-infection, all in the age group 15–64 years. Among TB patients aged 15–64 years who were HIV tested, those testing positive were significantly less likely to be female and to have respiratory TB and significantly more likely to have both respiratory and non-respiratory TB. The prevalence of HIV positivity in HIV-tested TB patients aged 15–64 years was 7.4% in 2003–2006.
Conclusion
ID=Universal HIV testing of TB patients is achievable through ‘opt-out’ HIV testing.
Key words: HIV, tuberculosis
Résumé
Objectif
ID=Le test de dépistage du VIH appliqué systématiquement chez les patients atteints de tuberculose, reconnu pour dépister plus de 80 % des nouveaux cas, a été recommandé au Canada, mais il n’a pas été fait. Les objectifs de cette étude étaient: 1) d’évaluer le succès d’une approche permettant de refuser le test, selon laquelle le dépistage du VIH est habituel à moins que le patient choisisse de le refuser, et 2) de déterminer les facteurs de risque pour le VIH chez les patients à qui on a fait passer le test de dépistage avant et après la mise en oeuvre de cette approche.
Méthode
ID=Les bases de données sur la tuberculose et le VIH dans la province de l’Alberta ont été croisées avant que le Traitement antirétroviral hautement actif (HAART) soit disponible (1991-1997), après la disponibilité du HAART, mais avant que le test de dépistage optionnel ne soit mis en place (1998-2002), et après la mise en oeuvre du test de dépistage optionnel (2003–2006), et l’état du VIH chez les patients atteints de tuberculose pour chaque période a été décrit. Les caractéristiques démographiques et cliniques des patients atteints de tuberculose et atteints du VIH ou non âgés de 15 à 64 ans ont été comparées.
Résultats
ID=Le test de dépistage du VIH chez les patients atteints de tuberculose est passé de 11,5 % avant la disponibilité du HAART, à 44,9 % après la disponibilité du HAART, mais avant le test de dépistage optionnel, à 81,9 % après la mise en oeuvre du test de dépistage optionnel. Entre 1991 et 2006, 50 patients atteints de tuberculose ont été diagnostiqués avec une infection au VIH; ces patients étaient tous âgés entre 15 et 64 ans. Parmi les patients atteints de tuberculose âgés de 15 à 64 ans qui ont été testés positifs pour le VIH, les patients testés positifs étaient beaucoup moins susceptibles d’être de sexe féminin et d’avoir la tuberculose respiratoire et beaucoup plus susceptibles d’avoir la tuberculose respiratoire et non respiratoire. La prévalence de la positivité au VIH chez les patients atteints de tuberculose testés positifs au VIH âgés entre 15 et 64 ans était de 7,4 % en 2003–2006.
Conclusion
ID=Le test de dépistage du VIH appliqué systématiquement chez les patients atteints de tuberculose est réalisable si l’on offre la possibilité de le refuser.
Mots clés: VIH, tuberculose
Footnotes
Acknowledgements: This work was supported by a grant from the University of Alberta Hospital Foundation. The authors thank the staff of the Disease Control and Prevention Branch, Alberta Health and Wellness and the staff of the Capital and Calgary TB Clinics for their assistance in assembling the TB data, the staff of the Northern and Southern Alberta HIV/AIDS Clinics for their assistance in assembling the HIV data, and the staff of the Provincial Laboratory for Public Health and the Tuberculosis Program Evaluation and Research Unit, University of Alberta, for their assistance in cross-matching HIV and TB data. The authors also thank Jennifer Parlevliet for her assistance in preparing the manuscript.
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