1. 1 How Complete is California’s HIV Status Determination Among 2008 TB Cases? Darryl Kong, MPH TB Control Branch California Department of Public Health October 22, 2010

2. 2 Background CDC recommends universal HIV testing for TB cases Changing HIV/TB epidemiology in CA, 1993 - 2008 Female Foreign Born Hispanic Asian Substance abusers White Black

3. 3 Responding to Epidemiologic Changes Monitor changing trends in HIV/TB Effective HIV testing in TB cases –Ensure appropriate treatment of coinfected cases –Ensure referral to HIV services

4. 4 Methods 1.HIV Status of All 2008 TB Cases Local TB Programs reviewed charts and databases to classify HIV status as: Positive Negative Indeterminate Refused Tested, Results Unknown Not Offered Unknown 2.HIV Testing Conditions of Sampled Cases 3.HIV/TB Management of Coinfected Cases

5. 5 1 st Stage Results 2672 TB cases reviewed –99% of reported cases –44/46 LHJs participated 1757 TB cases with a known HIV status –66% among reviewed cases 134 HIV/TB coinfected cases –5.0% among reviewed cases –7.6% among cases with known status

6. 6 HIV Status Determination is not Universal in CA CDC standard is universal testing of all TB cases

7. 7 Known HIV Status by Provider Type All Cases (N) Known Status (%) Coinfection Among All (%) Coinfection Among Known (%) Provider Type Health Dept1336764.55.9 Private821464.910.6 Both466706.79.5

8. 8 Known HIV Status by Age All Cases (N) Known Status (%) Coinfection Among All (%) Coinfection Among Known (%) Age 0-141553300 15-24276792.22.7 25-448047810.613.5 45-64819705.17.2 65+618450.20.4

9. 9 Known HIV Status by Sex and Selected Risk Factors All Cases N Known Status (%) Coinfection Among All (%) Coinfection Among Known (%) Sex Male1638686.810.1 Female1034622.13.4 Incarceration or Drug Use Yes1878217.721.6 No2485654.16.3

10. 10 Known HIV Status by Race and Nativity All Cases N Known Status (%) Coinfection Among All (%) Coinfection Among Known (%) Nativity Foreign Born2015674.16.1 US Born657617.812.7 Ethnicity White256636.610.6 Black2107212.917.8 Asian/PI1149600.91.5 Hispanic1048727.510.5

11. 11 Predictors of Known HIV status by Multivariate Analysis Excluded cases with only private management Factors associated with a known HIV status –Age (15-59 yrs old) –Male –Among Hispanics and Asians Foreign Born more likely than US Born

12. 12 Summary HIV status determination in CA is low Evidence of selective HIV status determination Gaps in HIV status determination found –Among privately managed cases –Among publicly managed cases Variation by age, sex, race/nativity

13. 13 Future Discussion How do we address gaps in HIV status determination –Among privately managed cases? –Among publicly managed cases? What are strategies to increase HIV status determination?

14. 14 Questions?

15. 15 Acknowledgements Local TB Program Staff TB Control Branch –James Watt –Jennifer Flood –Nicolette Palermo –Alicia Rodriguez Centers for Disease Control and Prevention –Suzanne Marks