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186931 Prevalence of latent tuberculosis infection (LTBI) and active TB among hidden populations at risk for HIV infection in Tijuana, Mexico: Project PreveTB

Monday, October 27, 2008: 2:45 PM

Richard S. Garfein, PhD, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Timothy C. Rodwell, MD, PhD, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Rafael Laniado-Laborín, MD , Coordinator of HIV/AIDS Program in Tijuana, ISESALUD Public Health Department, Tijuana, Mexico
Maria Remedios Lozada, MD , Coordinator of HIV/AIDS Program in Tijuana, ISESALUD Public Health Department, Tijuana, Mexico
Robert Deiss, MD , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Jazmine Cuevas, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Paris Cerecer, MD , Patronato Pro-COMUSIDA, Tijuana, Mexico
Kathleen Moser, MD, MPH , San Diego County Health and Human Services Agency, San Diego, CA
Antonino Catanzaro, MD , Department of Medicine/Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA
Maria Luisa Volker , Microbiology Department, Hospital General de Tijuana, Tijuana, Mexico
Steffanie A. Strathdee, PhD , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
BACKGROUND: Tijuana, Mexico, which has endemic tuberculosis (TB) and lies just south of San Diego, California, has an emerging HIV epidemic that could significantly increase TB incidence through the reactivation of undetected latent tuberculosis infections (LTBI). We screened high-risk individuals for HIV and TB to evaluate the extent of co-infection in Tijuana.

METHODS: We used street outreach to recruit injection drug users (IDUs), non-injecting drug users (NIDUs), commercial sex workers (CSWs), and homeless persons age >18 years for a behavioral risk assessment, rapid HIV testing and TB screening. TB screening was conducted with QuantiFERON® TB Gold In-Tube (QFT-GIT) assay and symptom histories. Participants reporting TB symptoms had acid-fast bacillus (AFB) smears performed on three sputum samples. Participants returned 3-4 weeks later for test results and referrals for care.

RESULTS: Overall, 503 participants were interviewed; 59% were male, median age was 36 years (IQR: 29-42), and only 24% had always lived in Tijuana. Overall prevalence was 57% for LTBI, 4.2% for HIV, and 2.2% for HIV/TB co-infection. None differed significantly by risk group (p>0.05). A total of 14 (2.8%) participants reported symptoms suggestive of active TB, of which 2 (incidence=398/100,000) were AFB(+) and referred for TB treatment.

CONCLUSIONS: LTBI is highly prevalent among hidden populations at risk for HIV/TB co-infection in Tijuana. Although the sample was small, active TB incidence was nearly 10 times greater than the general population (42/100,000) of Baja California. Community-based programs like “PreveTB” are needed to increase access to HIV/TB screening and services for hard-to-reach populations.

Learning Objectives:
1)Recognize the extent of the problem of latent tuberculosis infections in HIV infected individuals in Tijuana, Mexico 2)Describe new methods for detecting and diagnosing tuberculosis in hidden populations 3)Develop a plan for community-based tuberculosis diagnosis and prioritize strategies for treatment of individuals with latent tuberculosis

Keywords: Tuberculosis, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: 1) I was a senior epidemiologist with the HIV/AIDS Division at CDC from 1999 to 2005 2) I have been an associate professor in the Division of International Health at UCSD studying HIV and tuberculosis in Tijuana, Mexico since 2005
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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