695 Notice to Readers Missed Opportunities for Prevention of Tuberculosis Among Persons Wit.pdf

August 4, 2000 / Vol. 49 / No. 30 U.S. DEPARTMENT OF HEALTH HUMAN SERVICES Missed Opportunities for Prevention of Tuberculosis Among Persons With HIV Infection — Selected Locations, United States, 1996–1997 Public health contact investigations are conducted to find persons who have been exposed to patients with active tuberculosis (TB) and to evaluate and treat those con- tacts for TB infection and active TB. Persons in close (i.e., prolonged, frequent, or intense) contact with patients with active TB are at high risk for TB infection. The risk for TB infection is increased greatly if the close contact is infected with human immunodefi- ciency virus (HIV) (1,2 ). Isoniazid (INH) treatment for latent TB infection (LTBI) reduces the risk for developing active TB by 41%–92% (1 ). This study examined the clinic records of TB programs to determine whether these programs used recommended practices to manage HIV-positive persons exposed to TB (3–8 ). The study suggests TB programs need to review their contact investigation policies, procedures, and outcomes to reduce missed opportunities for preventing active TB among HIV-positive close contacts. Study investigators collected data during June 1998–January 1999 site visits. Eleven U.S. urban areas were selected by the highest number of contacts completing LTBI treatment. After case reports were linked to personal identifiers, study staff reviewed the clinic records for 6225 close contacts to 1080 sputum-smear–positive TB patients reported to CDC during July 1996–June 1997. Of the 6225 close contacts, HIV status was unknown for 5415 (87%). Of the 810 close contacts with known HIV status, 109 (13%) were HIV-infected, of whom 79 (72%) re- ceived a chest radiograph; 14 (13%) had TB symptoms (e.g., cough, night sweats, and weight loss); 90 (83%) received an initial tuberculin skin test (TST); and nine (8%) did not receive a chest radiograph or an initial TST. Forty (53%) of 75 TST-negative contacts did not receive follow-up TST