HIV screening in tuberculosis patients, in the northern region of Portugal

Abstract

Introduction: Portugal is the only western European country with an intermediate incidence of tuberculosis (TB) with a TB/HIV co-infection rate above the European average. HIV infection is a challenge to diagnosis, course and treatment of TB. Concerning the National Program for TB control, Portuguese health authorities determined that HIV screening must be performed in all patients with a TB diagnosis. However it is far from being accomplished. Objective: Identify which determinant factors are associated with an unknown HIV-status in TB patients from the Northern region of Portugal. Study design and Methods: We identified cases of active TB reported between 2006 and 2012, in the Northern region of Portugal. We considered 13 variables (sex, age, year of report, HIV-status, country of origin, region, co-morbidities, addictions, prison, homeless, community residence, main TB location, chest radiograph). A Logistic regression model was used to evaluate the differences between two groups: known HIV-status and unknown HIV-status. Results: During the period referred above 7683 cases were reported, 879 (11%) with an unknown HIV-status. Unknown HIV-status was associated with older individuals (OR: 2.77, 95%CI=1.722-1.805) and living outside Porto region (OR: 2.77, 95%CI=2,348-3,252). Patients having one or more co-morbidities (OR: 0.72, 95%CI=0.606-0.885) and with addictions (alcohol or durg abuse) (OR: 0.66, 95%CI=0,481-0,765) were those who had more HIV screening tests performed. Conclusions: HIV-status is usually unknown in older patients and those who live outside the city of Porto. Therefore it is necessary to understand the reasons behind this problem and promote strategies to solve it.