Background: Close contacts to persons with infectious TB are at high risk for TB infection. HIV(+) TB-infected persons are at extremely high risk for TB disease. Preventive therapy (PT) for TB infection is recommended for and should be completed by HIV(+) close contacts, regardless of tuberculin skin test (TST) results.
Methods: Selected 11 US sites and abstracted clinic records for a cohort of 6,225 close contacts to 1,080 persons with pulmonary, sputum-smear(+) TB reported to CDC July 1996 through June 1997.
Results: Of the 6,225 close contacts, HIV status was unknown for 87%; 109 were HIV(+) (1.8%). 13% of HIV(+) contacts were identified with TB disease, compared with 2% overall. Among HIV(+) contacts without TB disease (95), 32% were started on preventive therapy. A median of 50 days passed between identification of the HIV(+) contact and therapy start, versus 33 days for non-HIV(+). Public health nurses were more likely than outreach workers to start HIV(+), TST(-) contacts on presumptive PT. 10% of HIV(+) persons started on PT were placed on directly observed preventive therapy (DOPT). 47% of HIV(+) contacts started on PT completed treatment.
Conclusions: Most close contacts are not assessed for HIV. PT was provided to only 1/3 of known HIV(+) contacts. HIV(+) contacts are not more likely to complete PT than other contacts.
Recommendations: Health care providers should offer HIV counseling and testing to close contacts, follow CDC recommendations regarding prompt presumptive PT of HIV(+) close contacts, and ensure PT completion through DOPT or other adherence-promoting methods.
Learning Objectives: to enable participants to describe the risk of TB for HIV(+) close contacts to infectious TB cases and to enable health care providers to describe current needs for preventive TB therapy of HIV(+) close contacts
Keywords: Tuberculosis, HIV/AIDS
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.