The current TB screening practice among people living with HIV in the US is understudied. In our preliminary study, we found that only 6 (12%) US states recommended TB screening in their HIV guidelines; and only half of the Ryan White Programs capture client TB status. In this ongoing project, we aim to determine the prevalence of TB screening among people living with HIV in Arkansas, inform policy revisions, and ultimately reduce the burden of TB-HIV comorbidity.
We generated a sample of patients who received Ryan White service during the last grant year (April 1st, 2016 to March 31st, 2017) from CAREWare (Ryan White client database). We reviewed these patient files in multiple site visits and collected data on TB screening practice. We then performed descriptive analysis and multivariate logistic regression to analyze TB screening patterns in Arkansas.
To date, we reviewed 728 patient records from 22 clinics across Arkansas during a 6-month study period. 367 (50%) patients have baseline (HIV diagnosis) TB status. Based on the multivariate logistic regression model (adjusting for age, gender, race, and patient residence), TB screening among Ryan White patients vary significantly by clinical regions in Arkansas (p<0.0001). As compared to the central region, HIV patients in the North Central clinical region are more likely to be screened for TB (OR, 23.28; 95% CI, 5.29, 102.49); and HIV patients in the Northeast clinical region are less likely to be screened (OR, 0.05; 95%CI, 0.01, 0.30).
We observed in Arkansas (1) low adherence to recommendations for TB screening among people living with HIV and (2) insufficient HIV surveillance infrastructure to capture TB status, and (3) geographic variations in TB screening practice among people with HIV, indicating the need for (1) clearer guidelines, (2) stronger TB education among providers, and (3) program collaboration and service integration between TB and HIV.
In our next steps, we want to explore further into the regional variations in TB screening among people with HIV, in order to tailor interventions to different geographic regions. We also want to examine changes in TB screening practice after implementation of the new contract, and determine the optimal frequency of TB screening among people living with HIV.
L. Fischbach, None
T. Vance, None
C. Bedell, None
L. Mukasa, None