Experiences in implementation of routine human immunodeficiency virus testing in a US tuberculosis clinic

Int J Tuberc Lung Dis. 2012 Sep;16(9):1241-6. doi: 10.5588/ijtld.11.0628. Epub 2012 Jul 12.


Setting: Rhode Island Tuberculosis (RI TB) Clinic, The Miriam Hospital, Providence, RI, USA.

Background: Human immunodeficiency virus (HIV) status is a critical factor in the management of both patients with latent TB infection (LTBI) and active TB. Since 2006, the Centers for Disease Control and Prevention has recommended routine, opt-out HIV testing in all health care settings, including TB clinics. However, implementation of HIV testing in LTBI patients has been limited.

Design: A policy for HIV assessment of all new patients was instituted at the RI TB Clinic. Patients who reported no HIV testing in the preceding year were offered opt-out HIV testing. Patient records (June 2010-June 2011) were retrospectively reviewed. Structured nursing interviews assessed staff acceptance.

Results: A total of 821 (77.5%) first-visit TB patients underwent HIV status assessment: 96.3% of those not tested in the previous year agreed to testing; 65.9% of tests were performed at point of care. There was one new HIV diagnosis.

Conclusion: Implementing routine opt-out HIV testing in the RI TB Clinic is feasible, with high staff acceptance rates and low patient refusal rates. Perceived health systems barriers can be overcome. Incorporating opt-out HIV testing for LTBI patients expands testing opportunities to individuals unaware of their HIV status, and can identify HIV-infected patients early in the course of infection.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Coinfection*
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / epidemiology
  • HIV Infections / therapy
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Interviews as Topic
  • Latent Tuberculosis / diagnosis
  • Latent Tuberculosis / epidemiology
  • Latent Tuberculosis / therapy
  • Male
  • Mass Screening* / methods
  • Middle Aged
  • Outpatient Clinics, Hospital*
  • Patient Acceptance of Health Care
  • Perception
  • Point-of-Care Systems
  • Predictive Value of Tests
  • Program Development
  • Program Evaluation
  • Referral and Consultation
  • Retrospective Studies
  • Rhode Island / epidemiology
  • Time Factors
  • Tuberculosis / diagnosis*
  • Tuberculosis / epidemiology
  • Tuberculosis / therapy