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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

  1. Increase HIV Counseling, Testing, and Referral of close contacts to infectious TB patients
  2. Increase provider knowledge of HIV serostatus among close contacts
  3. Screen all HIV-infected contacts for active TB and for LTBI
  4. Prevent progression to active TB among HIV-infected contacts through LTBI treatment
  5. 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.

 
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