Objective: To determine whether Centers for Disease Control and Prevention recommendations for purified protein derivative (PPD) testing and tuberculosis (TB) preventive therapy for PPD-positive patients are implemented in HIV clinics.
Design: Retrospective medical chart review.
Setting: Ten hospital-based HIV clinics in New York City.
Participants: A total of 2397 patients with a first clinic visit in 1995.
Outcome measures: PPD testing of eligible patients, and recommendation of preventive therapy and completion of regimen in PPD-positive patients.
Method: Outpatient medical records were abstracted for TB history, PPD testing, TB preventive therapy, and patient demographic, social and clinical characteristics. Multivariate analyses were performed using logistic regression.
Results: Of 1342 patients with an indication for a PPD test, 865 (64%) were PPD tested in the clinic and 757 (88%) returned to have it read. Factors strongly associated with PPD testing in the clinic were number of visits, same sex behavior with men, and CD4+ lymphocyte count above 200 x 10(6)/l. Preventive therapy was recommended for 80% of newly identified PPD-positive patients and 22% of previously identified PPD-positive patients. Of 119 patients on preventive therapy in the clinic, 49 (41%) completed the regimen, 50 (42%) were lost to follow-up, and 20 (17%) discontinued therapy or their status could not be determined.
Conclusion: A significant number of missed opportunities to implement TB prevention practices were identified in HIV clinics. Focused attention in HIV clinics, and increased collaboration between HIV clinics and TB control programs may be needed to increase adherence to prevention guidelines.