Methods: We searched for existing policies at both national and state level. At the national level we searched guidelines, recommendations, and reports from CDC, HRSA, and NIH websites. At state level we examined TB and HIV guidelines and HIV surveillance reports from the Health Department websites for all 50 states.
Results: At the national level, NIH HIV/AIDS medical practice guidelines, and CDC website recommended Tb screening at diagnosis of HIV regardless of TB exposure, and routine TB screening for those at high risk of TB exposure. These recommendations trace back to 1995. However, there is no national data on TB prevalence among HIV-infected population. The CDC only published data from studies on smaller subgroups in 1989 and 1991, using matched data from TB case reports and AIDS registries. At the state level, only 2 states (Michigan. Missouri) reported the portion of HIV-infected patients with TB infection. Three states (Arizona, Mississippi, New York) recommended TB screening in HIV program guidelines. Twenty-three have specific recommendations on TB screening among HIV-infected patients in their TB Program Manual.
Conclusion: HIV surveillance infrastructure does not capture TB screening information. We are currently conducting a survey on TB surveillance in the HIV-infected population statewide to understand the extent HIV-TB surveillance in the United States. There are recommendations for TB screening among the HIV-infected population at the national level. There are some recommendations in place at the state level; however, these policies are not well implemented or practiced, resulting in the missed opportunity in prevention of TB among people living with HIV.
L. Fischbach, None
T. Vance, None
C. Bedell, None
L. Mukasa, None