15th Annual Conference of the British HIV Association 1-3 April 2009, Liverpool, UK

HIV PREVALENCE AND TESTING PRACTICES AMONG TUBERCULOSIS CASES IN LONDON

HIV Med 2009 Apr 1-3 (Suppl 1);15:12 (abstract no. O25)

A Rodger¹, A Hayward¹, Z Fox¹ and A Story^2
1University College London, London, UK, ²Health Protection Agency, London, UK

BACKGROUND: Universal testing for HIV in tuberculosis (TB) patients has been advocated for over a decade. Our aim was to determine factors predicting HIV test acceptance and HIV positivity in TB patients in London.

METHODS: A cohort study was undertaken of all TB patients in London in 2003 to 2004 (n=1941). Data include patient demographics, HIV test uptake rates, and test outcome. Logistic regression analysis was used to identify factors associated with being offered and accepting an HIV test and having a positive result.

RESULTS: The overall known prevalence of HIV was 9.9% (193/1941), with 52.5% (n=101) diagnosed prior to presentation with TB. Of those unaware of their HIV status at TB diagnosis (n=1840), 47.9% were offered testing. Only 27.0% of patients refused HIV testing if offered. The overall HIV prevalence in those with a test result (including those diagnosed previously) was 25.9%. In multivariate analysis, factors associated with being HIV positive were being female, aged <49 years, of black ethnicity and born overseas. The following were significantly more likely to be offered HIV testing; those aged <49 years (OR 2.2, 95% CI: 1.7, 2.9, P<0.0001), of black ethnic group (OR 2.60. 95% CI: 1.98, 3.41, P<0.001), with smear positive PTB (OR 1.8, 95% CI: 1.2, 2.7, P=0.006) and with a good understanding of English (OR 1.4, 95% CI: 1.1, 1.8, P=0.04). Factors associated with refusal of an offered test were, being female (OR 2.1, 95% CI: 1.5 to 3.1, P<0.001) or aged >49 years (OR 2.7, 95% CI: 1.8, 4.1, P<0.001). HIV status was associated with CNS disease (OR 1.75, CI 1.02, 3.02, P=0.003) but not with smear status, drug resistance or death.

CONCLUSIONS: Over half of TB patients in London in 2003/04 were not offered HIV testing. In those offered testing, uptake was high. Patients in higher risk groups were more likely to be offered testing, but even within the very highest risk groups testing was not universally offered. Healthcare staff should promote universal HIV testing in TB patients given the increased morbidity and mortality of co-infection, and identify barriers to acceptance of testing especially in women.

2009-04-01
O25

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