COINFECTION WITH MYCOBACTERIUM-TUBERCULOSIS AND HIV IN HIGH-RISK CLINICAL CARE SETTINGS IN RHODE-ISLAND

We assessed the extent to which co-infection with HIV and Mycobacteriu m tuberculosis (Mtb) was diagnosed at several high risk clinical care sites from 1992 to 1994 to determine whether surveillance for co-infec tion was performed. Information on PPD skin testing, HIV status, and H IV risk exposures was extracted from records at HIV clinics in Rhode I sland and a large database (HIV sites) and from records at the state T B clinic and the Rhode bland Health Department (TB sites). At the HIV sites, 34 of 1,408 HIV infected subjects were newly diagnosed with Mtb infection in the study period. At the TB sites, 16 of 1,389 subjects with newly diagnosed Mtb infection or disease were identified as HIV i nfected Eighty per cent of the records reviewed for this study were in complete. Hispanic subjects were at higher risk of being identified as co-infected at the HIV sites. At the TB sites, US-born subjects were at higher risk of being identified as co-infected. Recommendations for high risk individuals include yearly tuberculosis skin testing. Adher ence to these guidelines in selected high-risk clinical care sites in Rhode Island was substandard during the study period; the importance o f Mtb screening was demonstrated in this study. Identification of grou ps that are at higher risk of having HIV and Mtb co-infection identifi ed may enable health care providers to improve testing and prevention of tuberculosis at high risk clinical care settings.