Order #: 15113

Authors:

Barker, A., Alvarra, M., Caughlan, J., Post, P.

Title:

Comorbid TB and HIV in a Chronically Homeless Male: Social Isolation Compounds Stress of Medical Confinement.

Source:

Homeless Health Care Case Report: Sharing Practice-Based Experience 1(2): 1-7, 2006. (Newsletter: 7 Pages)

Abstract:

Of all tuberculosis (TB) cases reported in the United States between 1994 and 2003, over 6 percent were among persons classified as homeless during the 12 months prior to diagnosis; 34 percent of TB-infected homeless persons tested nationwide had coinfection with the human immunodeficiency virus (HIV).  In Maryland, the reported number of homeless persons with TB increased more than threefold between 2003 and 2004- from 4 cases (1.5 percent of all reported cases) to 15 cases (4.8 percent). During the same period, the overall incidence of TB in Baltimore increased from 4.9 cases to 5.6 cases per 100,000 population, while the national case rate decreased from 5.1 to 4.9 (authors). Available From: National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org.

Order #: 15511

Authors:

Macaraig, M., Agerton, T., Driver, C.R., Munsiff, S.S., Abdewahab, J., Park, J., Kreiswirth, B., Driscoll, J., Zhao, B.Y.

Title:

Strain-Specific Differences in Two Large Mycobacterium Tuberculosis Genotype Clusters in Isolates Collected from Homeless Patients in New York City from 2001 to 2004.

Source:

Journal of Clinical Microbiology 44(8): 2890-2896, 2006. (Journal Article: 7 Pages)

Abstract:

This study examined two large Mycobacterium tuberculosis genotype clusters associated with recent outbreaks in people experiencing homelessness to determine factors associated with these tuberculosis (TB) strains. Isolates from all culture-positive TB cases diagnosed from January 1, 2001 to December 31, 2004 were genotyped. Patients whose isolates had identical restriction fragment length polymorphism patterns and spoligotypes were considered clustered. Health department records were reviewed and reinterviews attempted for clustered cases. Patients with the Cs30 and BEs75 strains were compared to other genotypically clustered cases and to each other. The two largest genotype clusters among people experiencing homelessness were the Cs30 strain and the BEs75 strain. Fifty-one patients with the Cs30 strain and 28 with the BEs75 strain were experiencing homelessness. Compared to patients with the BEs75 strain, patients with the Cs30 strain were less likely to be respiratory acid-fast bacillus smear positive. Furthermore, patients with the BEs75 strain were more likely to be HIV infected, which suggests that most patients with this strain advanced to disease after recent infection. Cases in clusters of strains that have been circulating in the community over a long time period, such as the Cs30 strain, require additional investigation to determine whether clustering is a result of recent transmission or reactivation of remote infection [authors]. 

Order #: 15512

Authors:

Nyamathi, A.M., Christiani, A., Nahid, R., Gregerson, P., Leake, B.

Title:

A Randomized Controlled Trial of Two Treatment Programs for Homeless Adults with Latent Tuberculosis Infection.

Source:

International Journal of Tuberculosis and Lung Disease 10(7): 775-782, 2006. (Journal Article: 8 Pages)

Abstract:

This study's aims were to compare the effectiveness of an intervention program employing nurse case management and incentives (NCMI) vs. a control program with standard care and incentives on completion of latent tuberculosis infection (LTBI) treatment; and to compare the impact of the two programs on tuberculosis (TB) knowledge among participants. This was a prospective, two-group site-randomized design conducted among 520 adults experiencing homelessness residing in the Skid Row region of Los Angeles from 1998 to 2003, assessing completion rates of a 6-month isoniazid (INH) treatment program and change in TB knowledge. Using intent-to-treat analysis, 62% of participants in the intervention program, compared with 39% of controls, completed the full 6-month course of LTBI treatment with WH. Logistic regression modeling revealed that intervention participants had three times greater odds of completing INH treatment than controls. TB knowledge improved in both programs, but the increase was greater among the intervention participants. Nurse case management combined with education, incentives, and tracking dramatically improves both adherence to LTBI treatment and TB knowledge in persons experiencing homelessness compared to a standard approach of outreach and incentives [authors]. 

Order #: 14489

Authors:

Haddad, M.B., Wilson, T.W., Ijaz, K., Marks, S.M., Moore, M.

Title:

Tuberculosis and Homelessness in the United States, 1994-2003.

Source:

The Journal of the American Medical Association 293(22): 2790-2793, 2005. (Journal Article: 3 Pages)

Abstract:

This study sought to describe homeless persons with tuberculosis (TB) and to compare risk factors and disease characteristics between homeless and nonhomeless persons with TB.  Of 185,870 cases of TB disease reported between 1994 and 2003, 11,369 were among persons classified as homeless during the 12 months before diagnosis. The annual proportion of cases associated with homelessness was stable.  Individual TB risk factors often overlap with risk factors for homelessness, and the social contexts in which TB occurs are often complex and important to consider in planning TB treatment. Nevertheless, given good case management, homeless persons with TB can achieve excellent treatment outcomes (authors). 

Order #: 15250

Authors:

Pirl, W.F., Greer, J.A., Weissgarber, C., Liverant, G., Safren, S.A.

Title:

Screening for Infectious Diseases Among Patients in a State Psychiatric Hospital.

Source:

Psychiatric Services 56(12): 1614-1616, 2005. (Journal Article: 3 Pages)

Abstract:

This cross-sectional retrospective study examined the frequency of positive tests for infectious diseases among 655 patients who were admitted to a state psychiatric hospital from 1997 to 1999.  Not all patients who were admitted to the hospital were tested for each disease.  Rates of positive tuberculin, hepatitis B, and hepatitis C tests were all significantly greater than estimates for the U.S. general population.  A minority of patients were tested for HIV, and 29.0 percent were positive.  The rate of hepatitis A was similar to that in the general population.  Independent risk factors for markers of disease included age, immigrant status, homelessness, and history of substance use.  These results confirm the importance of screening for infectious diseases among individuals with severe and persistent mental illness (authors). 

Order #: 13792

Authors:

Centers for Disease Control and Preventon.

Title:

Updated Guildelines for the Use of Rifamycins for the Treatment of Tuberculosis Among HIV-Infected Patients Taking Protease Inhibitors or Nonnucleoside Reverse Transcriptase Inhibitors.

Source:

Atlanta, GA: Centers for Disease Control and Prevention, 2004. (Report: 6 pages)

Abstract:

In this report, the authors discuss two previously published reports which provided guidelines for managing the pharmacologic interactions that can result when patients are treated with protease inhibitors or nonnucleoside reverse transcriptase inhibitors (NNRTIs) for human immunodeficiency virus (HIV) infection together with rifamycins for tuberculosis (TB). The authors present current data pertaining to interactions between these agents, with recommendations for their use from a group of Center for Disease Control (CDC) scientists and outside expert consultants; these include initial recommendations for the protease inhibitors lopinavir/ritonavir, atazanavir, and fos-amprenavir (authors). Available From: Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-10, Atlanta, GA 30333, (404) 639-8135, www.cdc.gov/nchstp/tb/TB_HIV_Drugs/TOC.htm.

Order #: 14124

Authors:

Nyamathi, A., Sands, H., Pattatucci-Aragon, A., Berg, J., Leake, B.

Title:

Tuberculosis Knowledge, Perceived Risk and Risk Behaviors Among Homeless Adults: Effect of Ethnicity and Injection Drug Use.

Source:

Journal of Community Health 29(6): 483-497, 2004. (Journal Article: 15 Pages)

Abstract:

This study's objectives were to investigate Tuberculosis (TB) knowledge, perceived risk, and risk behaviors in a sample of homeless persons with latent TB in the Skid Row district of Los Angeles.  Particular emphasis was given to comparing these variables among homeless persons of varying ethnic backgrounds and among those who did and did not report a history of injection drug use (IDU).  Baseline data were collected from 415 homeless individuals recruited to participate in a Tuberculosis chemoprophylaxis intervention.  Areas of interest relative to TB knowledge and perceived risk for infection were behavioral factors surrounding substance use and abuse; personal factors measured in terms of current depression; and sociodemographic and situational factors, such as age, ethnicity, history of incarceration, and duration of homelessness.  Findings revealed differences in substance abuse.  IDUs were more likely to have histories of daily drug use and alcohol dependency, but were less apt to report recent use of crack cocaine.  TB knowledge deficits centered on ignorance with respect to modes of transmission and risk factors for TB infection.  IDU was also associated with depression.  Latinos and IDUs were most likely to lack TB knowledge.  There is a pressing need for accessible, available, culturally acceptable and sustained TB screening and intervention programs designed to address multiple risk factors and knowledge deficits with respect to TB infection in homeless populations (authors). 

Order #: 14414

Authors:

Kaufmann, S.H., Schaible, U.E.

Title:

A Dangerous Liaison Between Two Major Killers: Mycobacterium Tuberculosis and HIV Target Dendritic Cells Through DC-SIGN.

Source:

Journal of Experimental Medicine 197(1): 67-71, 2003. (Journal Article: 5 Pages)

Abstract:

Order #: 13249

Authors:

McElroy, P., Southwick, K., Fortenberry, E., Levine, E., Diem, L., Woodley, C., Williams, P., McCarthy, K., Ridzon, R., Leone, P.

Title:

Outbreak of Tuberculosis Among Homeless Persons Coinfected with Human Immunodeficiency Virus.

Source:

Clinical Infectious Diseases 36(10): 1305-1312, 2003. (Journal Article: 8 pages)

Abstract:

In this article, the authors investigated a cluster of patients with tuberculosis (TB) in North Carolina and determined the extent of transmission of one strain of Mycobacterium tuberculosis.  According to the article, a retrospective cohort study was conducted, and homeless shelter attendance and medical records for 1999 and 2000 were reviewed. The period of exposure to M. tuberculosis was determined, and shelter residents were offered TB screening.  The authors state that all but one patient was male, twenty-two were African American, and fourteen were human immunodeficiency virus-infected. The authors also assert that an epidemiological link to a single shelter was identified for all but one patient. The authors suggest that earlier recognition of this shelter as a site of M. tuberculosis transmission could have been facilitated through innovative approaches to contact investigation and through genetic typing of isolates (authors). 

Order #: 13252

Authors:

Munsiff, S., Nivin, B., Sacajiu, G., Mathema, B., Bifani, P., Kreiswirth, B.

Title:

Persistence of a Highly Resistant Strain of Tuberculosis in New York City During 1990-1999.

Source:

Journal of Infectious Disease 188(3): 356-363, 2003. (Journal Article: 7 pages)

Abstract:

This article discusses one multidrug-resistant Mycobacterium tuberculosis (MDRTB) strain, strain W, which caused several nosocomial outbreaks in New York City (NYC) during January 1990 through July 1993.  The authors reviewed all MDRTB cases verified during  August 1993 throught December 1999 that had isolates with either this DNA pattern or a variant of this strain, and compared them to the outbreak cases. The authors assert that of 427 DNA-confirmed cases from 1990 to 1999, one hundred-sixty-one were from August 1993 through December 1999 and constituted twenty-eight percent of all MDRTB cases in NYC during this period. The article states that compared with those from January 1990 through July 1993, patients from August 1993 through December 1999 were less likely to be infected with human immunodeficiency virus, to have been born in the United States, to be homeless, to have been incarcerated, and to have epidemiological links.  The article concludes that this strain was disseminated widely in the community during the outbreaks and that postoutbreak cases likely represent reactivated disease among individuals infected during the outbreak periods in the community (authors). 

Order #: 14415

Authors:

Paterson, R.

Title:

Initiative to Unify Control of HIV/AIDS and Tuberculosis.

Source:

The Lancet Infectious Diseases 3(3): 119, 2003. (Journal Article: 1 Pages)

Abstract:

Order #: 14031

Authors:

Cheung, R.C., Hanson, A.K., Maganti, K., Keeffe, E.B., Matsui, S.M.

Title:

Viral Hepatitis and Other Infectious Diseases in a Homeless Population.

Source:

Journal of Clinical Gastroenterology 34(4): 476-480, 2002. (Journal Article: 4 Pages)

Abstract:

This study's objective was to determine the prevalence of four common infectious diseases-hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and tuberculosis-as well as co-infection rates and risk factors in a homeless population.  The prevalence of infectious diseases, especially viral hepatitis, among the homeless population is largely unknown.  This study consists of a retrospective analysis of the history and laboratory data collected from all homeless veterans admitted to a Veterans Administration (VA) domiciliary from May 1995 to March 2000.   Of the homeless veterans admitted to a VA domiciliary program, 597 of 829 were screened for markers of all four infectious diseases.  The overall prevalence of anti-hepatitis C virus (HCV) antibody, and positive result for purified protein derivative (PPD), anti-HIV antibody, and hepatitis B surface antigen (HbsAg) were 41.7%, 20.6%, 1.84% and 1.17%, respectively.  At least one of the four markers was positive in 52.6% and more than one in 12%.  Co-infection with HCV occurred commonly in veterans who were positive for anti-HIV and HBsAg.  Four self-reported major risk factors (intravenous drug use, alcohol abuse, previous imprisonment, and prior stay in a shelter) were evaluated.  Multivariate analysis indicates that intravenous drug use and anti-HBs reactivity are independent risk factors for HCV infection, HCV infection for anti-hepatitis B surface antibody reactivity, and older age for PPD positivity.  Chronic hepatitis C and co-infections are common among the homeless population.  Patients infected with HIV and hepatitis B virus frequently are co-infected with HCV.  Infections frequently are associated with certain identifiable risk factors (authors). 

Order #: 14416

Authors:

Chinai, R.

Title:

Raju Has TB and AIDS and Lives on the Street.

Source:

Bulletin of the World Health Organization 80(6): 519-520, 2002. (Journal Article: 2 Pages)

Abstract:

Order #: 13472

Authors:

Ellis, B., Crawford, J., Braden, C., McNabb, S., Moore, M., Kammerer, S.

Title:

Molecular Epidemiology of Tuberculosis in a Sentinel Surveillance Population.

Source:

Emerging Infectious Diseases 8(11): 1197-1209, 2002. (Journal Article: 12 pages)

Abstract:

In this article, the authors conducted a population-based study to assess demographic and risk-factor correlates for the most frequently occurring Mycobacterium tuberculosis genotypes from tuberculosis (TB) patients. The study included all incident, culture-positive TB patients from seven sentinel surveillance sites in the United States from 1996 to 2000.  The article states that overall, forty-eight percent of cases had isolates that matched those from another patient, including sixty-four percent  of U.S. born and thirty-five percent of foreign-born patients.  The authors identified risk factors for clustering of genotypes as: being male, U.S. born, black, homeless, and infected with HIV; having pulmonary disease with cavitations on chest radiograph and a sputum smear with acid-fast bacilli; and excessive drug or alcohol use. The article asserts that molecular characterization of TB isolates permitted risk correlates for clusters and specific genotypes to be described and provided information regarding cluster dynamics over time (authors). 

Order #: 12594

Authors:

Estrada, A.

Title:

Epidemiology of HIV/AIDS, Hepatits B, Hepatitis C, and Tuberculosis Among Minority Injection Drug Users.

Source:

Public Health Report 117(1): 126-134, 2002. (Journal Article: 9 pages)

Abstract:

This article reviews the literature on the impact of AIDS, hepatitis B and C viruses, and tuberculosis on minority drug injection users in the United States.  According to the author, minority drug injectors are disproportionately represented in the national statistics on these infections.  Behavioral epidemiologic studies show that both injection-related risk factors and sex-related risk factors are conducive  to the spread of HIV, HBV, and HCV.  The authors state that two issues must be addressed to halt the spread of HIV infection and hepatitis Band C, and that the capacity of syringe-exchange programs to refer participants to drug treatment programs and facilitate access to health and social services must be increased.  The development of culturally appropriate behavioral interventions targeting risk behaviors among ethnic and racial minorities, especially women is suggested (authors). 

Order #: 14417

Authors:

Garcia de Olalla, P., Martinez-Gonzalez, M.A., Cayla, J.A., Jansa, J.M., Iglesias, B., Guerrero, R., Marco, A., Gatell, J.M., Ocana, I.

Title:

Influence of Highly Active Anti-Retroviral Therapy (HAART) on the Natural History of Extra-Pulmonary Tuberculosis in HIV Patients.

Source:

The International Journal of Tuberculosis and Lung Disease 6(12): 1051-1057, 2002. (Journal Article: 7 Pages)

Abstract:

This study's objective was to determine factors related to survival in acquired immune-deficiency syndrome (AIDS) patients with extra-pulmonary tuberculosis (EPTB), when this condition is the first AIDS-defining disease.  A retrospective cohort-study of 549 AIDS patients with EPTB as the first AIDS-defining disease was conducted.  Potential candidates to predict survival were sex, human immunodeficiency virus (HIV) exposure, the coexistence of pulmonary and EPTB at diagnosis, tuberculin skin test, directly observed therapy for tuberculosis (DOT), and highly active anti-retroviral therapy (HAART).  The Kaplan-Meier method and Cox regression models were used to assess factors associated with survival.  Estimated 3-year survival was 47.0% for those diagnosed before 1993, 72.6% for patients with first AIDS diagnosis during 1995-1996 and 84.6% for those diagnosed after 1996.  A negative tuberculin test, not being on DOT and having pulmonary tuberculosis involvement also were independently associated with poorer survival.  The survival of patients significantly improved after the introduction of HAART.  The survival of HIV patients with EPTB as their first AIDS-defining disease has substantially improved during the last decade.  A negative tuberculin skin test and not receiving DOT are associated with poorer survival among HIV-infected patients whose first AIDS-defining disease is EPTB (authors). 

Order #: 14418

Authors:

Libbus, M.K., Phillips, L.J., Knudson, K.

Title:

TB-HIV Registry Matching in Missouri, 1987-1999.

Source:

Public Health Nursing 19(6): 470-474, 2002. (Journal Article: 5 Pages)

Abstract:

This study investigated whether all cases of mycobacterium tuberculosis (MTB) reported to the HIV/AIDS Registry (HARS) in Missouri were also reported to the Tuberculosis Information Management System (TIMS) to determine the sensitivity of TIMS and the predictive value of HARS.  Wthe authors found 262 total MTB cases registered in HARS.  Of those, 145 were included in the TIMS.  Thirty-eight of the remaining 117 were caused by mycobacteria other than TB, leaving 79 for investigation.  Chart review of the 79 revealed 16 cases of MTB.  Sensitivities and predictive values were calculated first including unknown/unreported group as being MTB-positive and the second including this group as being MTB-negative.  Sensitivities for TIMS were 83 and 90%, respectively, and predictive values for HARS were 68 and 63%, respectively.  The fact that there were at least 16 unreported cases of MTB has significant public health implications for TB control in Missouri.  Public health nursing could work with HARS surveillance staff to help improve the accuracy of case finding and reporting.  By whatever means necessary, communications between the TB and HIV programs within the Missouri Department of Health should be enhanced (authors). 

Order #: 14419

Authors:

Badri, M., Ehrlich, R., Wood, R., Pulerwitz, T., Maartens, G.

Title:

Association Between Tuberculosis and HIV Disease Progression in a High Tuberculosis Prevalence Area.

Source:

The International Journal of Tuberculosis and Lung Disease 5(3): 225-232, 2001. (Journal Article: 8 Pages)

Abstract:

This study's objective was to assess the impact of tuberculosis on HIV-1 disease progression in an area with high tuberculosis prevalence and minimal antiretroviral therapy use.  A prospective patient cohort study was conducted in adult human immunodeficiency virus (HIV) clinics affiliated with the university of Cape Town, South Africa.  Factors such as age, race, risk status, CD4+ T-lymphocyte count, history of AIDS, prophylactic co-dependents, and Cox proportional hazards regression models were evaluated.  Tuberculosis fulfilling the case definition developed in 158/609 patients in the 5-year observation period.  Tuberculosis was associated with an increased risk of AIDS.  In a stratified analysis, the increased mortality associated with tuberculosis was observed only in patients with CD4+ T-lymphocyte count > 200 cells/microliter and in those without AIDS at baseline.  The onset of tuberculosis in HIV-infected patients is associated with an increased risk of AIDS and death.  Although a casual link cannot be established in an observational study, our findings support the view that prolonged immune activation induced by tuberculosis leads to prolonged increased HIV replication and consequent accelerated disease progression (authors). 

Order #: 14202

Authors:

Brewer, T.F., Heyman, S.J., Krumplitsch, S.M., Wilson, M.E., Colditz, G.A., Fineberg, H.V.

Title:

Strategies to Decrease Tuberculosis in U.S. Homeless Populations: A Computer Simulation Model.

Source:

Journal of the American Medical Association 286(7): 834-42, 2001. (Journal Article: 9 Pages)

Abstract:

The objective of this article is to examine the effects of tuberculosis (TB) control strategies on projected TB cases and deaths in U.S. homeless populations using a computer-based simulation model.  The U.S. general population and a theoretical population of 2 million homeless individuals in 1995 were divided into 18 clinical states based on the risk for the presence of TB and human immunodeficiency virus (HIV) infected in a semi-Markov model.  The main outcome measures used were prevalence of transiently and chronically homeless individuals with active TB and deaths from TB as a function of public health measures taken to control and eliminate TB, including improvement of treatment effectiveness, improvement of treatment effectiveness, improvement in access to treatment, and vaccination with BCG.  A 10% increase in access to treatment among homeless persons with active TB produced larger declines in predicted TB cases and deaths after 10 years than improvements in the effectiveness of treatment programs.  A 10% increase in access to treatment among homeless persons with latent TB infection led to a 6.7% decline in TB among chronically homeless persons and a 5.7% decline among transiently homeless persons, while a 10% improvement in effectiveness of treatment for latent TB infection was associated with declines of 3.0% and 3.3%, respectively.  When treatment for latent TB infection was modeled to be the same in vaccinated and non-vaccinated populations, BCG vaccination led to TB case declines of 15.4% and 21.5% in chronically and transiently homeless populations, respectively.  Overcoming barriers faced by homeless individuals in accessing TB treatment programs will be crucial to reducing the burden of TB in the high-risk group.  Increased treatment access, improvement in the effectiveness of treatment programs, and BCG vaccination of HIV-negative homeless individuals have the best chance to markedly decrease TB morbidity and mortality (authors). 

Order #: 14420

Authors:

Burman, W.J., Jones, B.E.

Title:

Treatment of HIV-Related Tuberculosis in the Era of Effective Antiretroviral Therapy.

Source:

American Journal of Respiratory and Critical Care Medicine 164(1): 7-12, 2001. (Journal Article: 6 Pages)

Abstract:

Order #: 12487

Authors:

Raoult, D., Foucault, C., Brouqui, P.

Title:

Infections in the Homeless.

Source:

The Lancet Infectious Diseases 1(2): 77-84, 2001. (Journal Article: 8 pages)

Abstract:

This article discusses the specific problems people who are homeless have, which predispose them to infectious diseases.  Respiratory infections and outbreaks of tuberculosis and other aerosol transmitted infections are discussed.  The authors state that intravenous drug users are at an increased risk of contracting HIV, and hepatitis B and C infections.  Skin problems, such as scabies, pediculosis, impetigo and tinea infections, as well as food disorders like cellulitis, gas gangrene and erysipelas are reported as most common ailments among people who are homeless, and are also discussed.  The authors explain treatment complications when serving the homeless population, including self-neglect, lack of adherence and financial constraints (authors). 

Order #: 14423

Authors:

Riley, E.D., Chaisson, R.E., Robnett, T.J., Vertefeuille, J., Strathdee, S.A., Vlahov, D.

Title:

Use of Audio Computer-Assisted Self-Interviews to Assess Tuberculosis-Related Risk Behaviors.

Source:

American Journal of Respiratory and Critical Care Medicine 164(1): 82-85, 2001. (Journal Article: 4 Pages)

Abstract:

This study's objective was to compare self-reported TB and HIV risk factors obtained from computer assisted and interviewer-assisted questionnaires among participants of a needle exchange program.  Between June 1998 and May 1999, needle exchange program participants requesting TB screening underwent interviews regarding demographics and risk factors for TB and HIV infection.  The first 190 participants underwent traditional interviewer-assisted questionnaires, whereas the remaining 92 underwent computer-assisted questionnaires.  Among 282 participants, demographic characteristics, health status, HIV serostatus, visits to homeless shelters, alcohol intake, and cigarette smoking were all similar by interview technique.  However, respondents receiving computer-assisted questionnaires were more likely than those receiving interviewer-assisted questionnaires to report smoking marijuana, crack, and heroin; as well as sharing cocaine smoking equipment, sharing heroin smoking equipment, shotgunning, and visiting crack houses.  In the final model, respondents receiving computer-assisted questionnaires were more likely to report shotgunning and visiting a crack house relative to respondents receiving interviewer-assisted questionnaires (authors). 

Order #: 14424

Authors:

Sackoff, J.E., Torian, L.V., Frieden, T.R.

Title:

TB Prevention in HIV Clinics in NY City.

Source:

The International Journal of Tuberculosis and Lung Disease 5(2): 123-128, 2001. (Journal Article: 6 Pages)

Abstract:

This study's objective was to evaluate tuberculosis (TB) prevention in HIV clinics based on the prevalence and incidence of TB and the efficacy of preventative therapy with isoniazid (INH).  The medical records of 2393 HIV infected patients with a first clinic visit in 1995 were reviewed retrospectively.  Deaths and TB cases through December 1997 were ascertained through a match the TB and AIDS registries.  At first visit, 92 patients had a history of TB, 98 were being treated for TB, and six were diagnosed with TB.  During follow-up, 23 cases were diagnosed, and the incidence was 0.53 per 100 person-years (py).  Among 439 tuberculin skin test (TST) positive patients, the incidence of TB/100 py was 1.63 in patients with no INH, 1.28 in patients with <12 months of INH, and 1.06 in patients with 12 months of INH.  The incidence/100 py was 0.0 in TST-negative patients and 0.37 in anergic patients.  The relative risk of TB was 0.65 in TST-positive patients with 12 months of INH.  The benefits of TB prevention efforts in these HIV clinics from 1995 to 1997 were limited because most TB occurred before the first clinic visit.  Methods for reaching HIV-infected patients earlier should be identified (authors). 

Order #: 14203

Authors:

Jerant, A.F., Bannon, M., Rittenhouse, S.

Title:

Identification and Management of Tuberculosis.

Source:

American Family Physician 61(9): 2667-2678, 2681-2682, 2000. (Journal Article: 14 pages)

Abstract:

This article looks at how although the resurgence of tuberculosis in the early 1990s has largely been controlled, the risk of contracting the disease remains high in homeless persons, recent immigrants and persons infected with the human immunodeficiency virus (HIV).  Purified protein derivative testing should be targeted at these groups and at persons with known or suspected exposure to active tuberculosis.  Most patients with latent tuberculosis are treated with isoniazid administered daily for nine months.  In patients with active tuberculosis, the initial regimen should include four drugs for at least two months, with subsequent therapy determined by mycobacterial sensitivities and clinical response.  To avoid harmful drug interactions, regimens that do not contain rifampin may be employed in HIV-infected patients who are taking protease inhibitors or nonucleoside reverse transcriptase inhibitors.  To maximize compliance and minimize the emergence of mycobacterial drug resistance, family physicians should consider using directly observed therapy in all patients with tuberculosis (authors). 

Order #: 8443

Authors:

Murphy, D.A., Rotheram-Borus, M.J., Joshi, V.

Title:

HIV-infected Adolescent and Adult Perceptions of Tuberculosis Testing, Knowledge and Medication Adherence in the USA.

Source:

AIDS Care Journal 12(1): 59-63, 2000. (Journal Article: 5 pages)

Abstract:

HIV-infected adolescent and adult perceptions of tuberculosis (TB) infection rates and physician TB behaviour, and patient knowledge of TB transmission and treatment adherence were assessed.  HIV-infected youth from adolescent clinical care sites in three cities and HIV-infected adults in New York were interviewed.  Adolescent self-report was compared to medical chart review.  Adolescents reported they were significantly less likely to be tested, although testing rates were high for both samples.  Approximately 9% of both samples reported infection with TB; the majority of whom reported receiving medication, and consistent medication adherence.  The overall mean knowledge score was 66%, with significant age differences: adolescents were less knowledgeable than adults, and young males tended to be less knowledgeable than young females.  Age, gender and experience with TB (self-perception of TB, testing history and clinic choice) significantly predicted accuracy of knowledge about TB.  Results suggest that if HIV-infected individuals, a population at very high risk and often among the least able to afford health care resources, receive the education and support they need from their community health care sources they may substantially reduce their chances of contracting and spreading TB (authors). 

Order #: 9454

Authors:

DeRiemer, K., Daley, C.L., Reingold, A.L.

Title:

Preventing Tuberculosis Among HIV-Infected Persons: A Survey of Physicians' Knowledge and Practices.

Source:

Preventative Medicine 28(4): 437-444, 1999. (Journal Article: 8 pages)

Abstract:

Guidelines exist for screening, diagnosing, and preventing tuberculosis (TB) among HIV-infected persons, but their application and utility are unknown.  The authors conducted a survey of knowledge and practices among 1,300 physicians in the San Francisco Bay area to assess their practices towards TB among HIV-infected persons.  Of 630 respondents, 350 provided care for HIV-infected persons.  Thirty-four percent of the respondents had seen the most recent guidelines for preventing tuberculosis among HIV-infected persons; 65% routinely provide information to HIV-infected patients about the risks of exposure to Mycobacterium tuberculosis; 39% provide annual tuberculin skin testing (TST) to HIV-infected patients without a history of a positive test; 86% knew that >/=5-mm induration is considered a positive TST result in HIV-infected persons; and 47% provide a 12-month regimen of chemoprophylaxis for HIV-infected persons who have a positive TST but not active tuberculosis.  Physician specialty and experience with HIV-infected persons were not strongly correlated; experience was a better predictor of correct knowledge and practices.  Many physicians were not aware of the standards of care for preventing tuberculosis among HIV-infected patients, even in a geographic area with a high prevalence of M. tuberculosis and HIV (authors). 

Order #: 9455

Authors:

Dievler, A., Pappas, G.

Title:

Implications of Social Class and Race for Urban Public Health Policy Making: A Case Study of HIV/AIDS and TB Policy in Washington, DC.

Source:

Social Science and Medicine 48(8): 1095-1102, 1999. (Journal Article: 8 pages)

Abstract:

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policy-making by the Washington, DC Commission of Public Health, Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems; there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy. 

Order #: 9456

Authors:

Mehta, J.B., Roy, T.M., Hughes, S.K., Byrd Jr., R.P., Harvill, L.M.

Title:

Demographic Changes in Tuberculosis: High Risk Groups.

Source:

Southern Medical Journal 92(3): 280-284, 1999. (Journal Article: 5 pages)

Abstract:

The authors conducted a statistical analysis of all verifiable tuberculosis (TB) cases in Tennessee from 1990 through 1996 to determine the demographic changes in TB.  They studied variables, including age, sex, race, site of the disease, and possible impact of known risk factors such as human immunodeficiency virus (HIV) infection, homelessness, foreign birth, and residency in extended care facility.  The percentage increase in all such categories, except in the nursing home population, had a statistically significant increase.  Unlike national epidemiologic findings, foreign-born TB comprised less than 1% of the total cases.  Association of HIV as a co-infection increased from 16 in 1990 to 41 in 1996.  These findings will have significant impact on TB control measures and the clinical practice of TB cases in Tennessee and other areas of the southeastern U.S. 

Order #: 9457

Authors:

Schluger, N.W.

Title:

Issues in the Treatment of Active Tuberculosis in Human Immunodeficiency Virus-infected Patients.

Source:

Clinical Infectious Diseases 28(1): 130-135 1999. (Journal Article: 6 pages)

Abstract:

Most HIV-infected patients with TB can be treated satisfactorily with standard regimens with expectations of good results. Treatment of TB in these patients has been complicated by the introduction of HAART, which relies on drugs that interfere with the most potent class of antituberculous medications. Rifampin-free regimens or regimens that employ rifabutin may be acceptable strategies for patients who are receiving protease inhibitors, although these regimens have not been rigorously evaluated in patients with AIDS. At present, there is good reason to believe that a 6-month course of a rifabutin-containing regimen or a 9-12-month course of a regimen of streptomycin, isoniazid, and pyrazinamide should be adequate therapy for most patients with drug-susceptible disease. As the treatment of HIV infection with antiretroviral agents evolves, the treatment of TB in patients with AIDS is likely to evolve as well. This will require careful coordination of antituberculosis and antiretroviral therapies. 

Order #: 9458

Authors:

Telzak, E.E., Chirgwin, K.D., Nelson, E.T., Matts, J.P., Sepkowitz, K.A., Benson, C.A., Perlman, D.C., El-Sadr, W.M.

Title:

Predictors for Multidrug-resistant Tuberculosis Among HIV-infected Patients and Response to Specific Drug Regimens.

Source:

Terry Beirn Community Programs for Clinical Research on AIDS and the AIDS Clinical Trials Group, National Institutes for Health. International Journal of Tubercle and Lung Disease 3(4): 337-343, 1999 (Journal Article: 7 pages)

Abstract:

Mortality associated with human immunodeficiency virus (HIV) related multidrug-resistant tuberculosis (MDR-TB) is reduced with effective early therapy.  Identifying predictors of, and effective regimens for, MDR-TB is critical.  A multicenter prospective study was initiated to determine the demographic, behavioral, clinical and geographic risk factors associated with the occurrence of MDR-TB among HIV-infected patients; and to evaluate the overall survival and clinical response of MDR-TB patients treated with specific drug regimens.  Patients were prospectively evaluated for MDR-TB.  Information included history of prior treatment for tuberculosis, close contact with a known case of MDR-TB, and residence in a facility with known or suspected MDR-TB transmission.  Patients with known MDR-TB, or those suspected to be at high risk, were offered enrollment in a treatment pilot study.  Study drugs included levofloxacin and at least two additional drugs to which the patient's isolate was known, or most likely, to be susceptible.  Survival was the primary endpoint.  Complete data are available for 156 HIV-infected patients with confirmed tuberculosis.  Sixteen had MDR-TB.  Only a history of prior tuberculosis treatment was associated with MDR-TB in multivariate analysis.  Twelve patients with MDR-TB enrolled in the treatment pilot had a median CD4 cell count of 51/mm3.  The cumulative probability of survival at one year was 75% and at 18 months, 65.6%.  Toxicity requiring discontinuation of medications occurred in two patients.  A history of treatment for tuberculosis was the only predictor for MDR-TB in a cohort of HIV-infected patients with tuberculosis.  In addition, this prospective study supports the results of prior retrospective studies that effective treatment impacts on mortality.  Current second line treatment, including high dose levofloxacin, appears to be reasonably well tolerated (authors). 

Order #: 7926

Authors:

Weis, S.E.; Foresman, B.; Cook, P.; Matty, K.

Title:

Universal HIV Screening at a Major Metropolitan TB Clinic: HIV Prevalence and High-Risk Behaviors Among TB Patients.

Source:

American Journal of Public Health, 89(1): 73-75, 1999. (Journal Article: 3 pages)

Abstract:

This study assessed the outcome of implementing a policy of universal screening of patients with TB for HIV infection at a major metropolitan public health TB clinic.  HIV serologic testing was completed on 768 of 825 eligible patients.  Ninety-eight HIV-positive cases were compared with 670 HIV-negative cases.  The presence of adult HIV risk factors was determined by structured interview and review of medical records.  One or more HIV risk factors were present in 93% of HIV-positive and 42% of HIV-negative cases.  The metropolitan TB clinic is well suited for HIV screening, and HIV-antibody testing and counseling should be provided to all TB patients (authors). 

Order #: 9459

Authors:

Wroten, J.E., Crockett, L.K., Kertesz, C.

Title:

Trial Marriage: Florida's Experience in Consolidating HIV/AIDS, STD, and TB programs.

Source:

Public Health Report 114(1): 74-80, 1999. (Journal Article: 7 pages)

Abstract:

After a three-year experiment in consolidating services, the Florida Department of Health has again separated programs for the prevention and control of HIV/AIDS, sexually transmitted diseases (STDs), and tuberculosis. The authors report that while there were some clear advantages to consolidating services, especially programs dealing with HIV and other STDs, the individual programs suffered in some important ways. The authors describe Florida's effort to preserve the positive programmatic and administrative aspects of the consolidated approach and to apply the lessons learned. 

Order #: 8255

Authors:

Centers for Disease Control and Prevention.

Title:

Prevention and Treatment of Tuberculosis Among Patients Infected with Human Immunodeficiency Virus: Principles of Therapy and Revised Recommendations.

Source:

Morbidity and Mortality Weekly Report 47(RR-20): 1-58, 1998. (Guide: 58 pages)

Abstract:

These guidelines update previous CDC recommendations for the diagnosis, treatment, and prevention of TB among adults and children co-infected with HIV in the U.S. The most notable changes in these guidelines reflect both the findings of clinical trials that evaluated new drug regimens for treating and preventing TB among HIV-infected persons and recent advances in the use of antiretroviral therapy. Available From: CDC National Prevention Information Network, P.O. Box 6003, Rockville, MD 20850, (800) 458-5231.

Order #: 9460

Authors:

Glynn, J.R.

Title:

Resurgence of Tuberculosis and the Impact of HIV Infection.

Source:

British Medical Bulletin 54(3): 579-593, 1998. (Journal Article: 15 pages)

Abstract:

Tuberculosis is increasing in many countries. In some areas the major influences on tuberculosis trends are the traditional ones: poverty, failures in the treatment system, and immigration. In others areas, the HIV epidemic is having a huge impact. HIV infection increases the risk of tuberculosis approximately 7-fold, though this may vary with the stage of the HIV epidemic, the prevalence of tuberculosis, and the age groups considered. Dually-infected individuals develop tuberculous disease at a rate of 5-10% per year. HIV also increases the risk of disease following recent infection, which makes a major contribution to the tuberculosis burden in some settings. HIV-infected individuals, may transmit Mycobacterium tuberculosis less than HIV-negative individuals do, but the extra cases will add to the transmission overall, and evidence of HIV-attributable increases in the annual risk of infection is beginning to be seen. 

Order #: 9461

Authors:

Messmer, P.R., Jones, S., Moore, J., Taggart, B., Parchment, Y., Holloman, F., Quintero, L.M.

Title:

Knowledge, Perceptions, and Practice of Nurses Toward HIV+/AIDS Patients Diagnosed with Tuberculosis.

Source:

Journal of Continuing Education for Nurses 29(3): 117-125, 1998. (Journal Article: 9 pages)

Abstract:

Tuberculosis (TB) continues to be a major health problem in the United States.  Nurses may be exposed to TB and not realize their risks for becoming infected.  The presentation of HIV-associated TB is somewhat different from standard TB.  The purpose of this study was to determine if an educational program could improve nurses' attitudes, level of knowledge, and compliance with infection control standards for HIV/AIDS patients diagnosed with TB.  Participants included 50 staff nurses.  The experimental group and control group completed a knowledge test and an attitude survey.  Researchers observed participants for compliance with infection control standards pretest and posttest.  Following an educational program, the experimental group demonstrated a greater knowledge of TB than the control group who did not participate in the educational program.  In addition, the experimental group had a greater improvement in their Nursing precaution protocols scores as compared to the control group.  However, there was not a tangible increase in knowledge level of AIDS, attitudes or concerns about caring for these patients.  This nursing research study supports the need for an ongoing educational program with continual monitoring of infection control practices to positively affect client and caregiver outcomes (authors). 

Order #: 9462

Authors:

Alpert, P.L., Munsiff, S.S., Gourevitch, M.N., Greenberg, B., Klein, R.S.

Title:

A Prospective Study of Tuberculosis and Human Immunodeficiency Virus Infection: Clinical Manifestations and Factors Associated with Survival.

Source:

Clinical Infectious Diseases 24(4): 661-668, 1997. (Journal Article: 8 pages)

Abstract:

We prospectively studied the effect of human immunodeficiency virus (HIV) infection on the presentation and outcome of tuberculosis. A total of 216 patients with tuberculosis were identified; 162 of these patients were tested for antibodies to HIV; 92 were seropositive. The patients who were seropositive for HIV were more likely to be male and Hispanic and to have been homeless or incarcerated. Eighty-one percent of these patients had CD4 lymphocyte counts of less than or equal to 200/mm3. The seropositive patients had extrapulmonary tuberculosis more often than did the seronegative patients. Smears for acid-fast bacilli were positive more often for non-HIV-infected patients with pulmonary tuberculosis than for HIV-infected patients (even those with focal or cavitary disease).  A delay in initiating therapy was associated with in-hospital mortality: The median time from admission to the start of treatment was 4 days for patients who survived and 15 days for those who died. The median survival was 22.7 months for HIV-infected patients who did not die during the initial hospitalization. Factors independently associated with reduced rates of survival included the severity of immunodeficiency, nonuse of directly observed therapy, infection due to drug-resistant Mycobacterium tuberculosis, and a history of injection drug use (authors). 

Order #: 9463

Authors:

Farmer P.

Title:

Social Scientists and the New Tuberculosis.

Source:

Social Science and Medicine 44(3): 347-358, 1997. (Journal Article: 12 pages)

Abstract:

In much of the world, tuberculosis (TB) remains the leading killer of young adults, in spite of the fact that effective chemotherapy has existed for 50 years. The epidemiology of TB, with its persistence in poor countries and resurgence among the poor of many industrialized nations, causes consternation among those charged with protecting the public's health. Two factors, ostensibly biological in nature, are commonly cited to explain this setback: the advent of HIV and the emergence of TB strains resistant to multiple drugs (MDR TB). But the strikingly patterned occurrence of MDR TB-in the United States afflicting those in homeless shelters and in the inner city, for example-speaks to some of the large-scale social forces at work in the new epidemic, which began before the advent of HIV. These forces (which include poverty, economic inequality, political violence, and racism) are examined through the experience of a young Haitian man with MDR TB, a disease never before described in Haiti. Insights from this case, and from other research on TB and HIV disease, are considered in the light of past anthropological writings on TB. It is argued that, often, social scientists mar contributions to an understanding of TB by making "immodest claims of causality" regarding its distribution and course. Alternative strategies for future sociomedical research on MDR TB are proposed. 

Order #: 9464

Authors:

Lienhardt, C., Rodrigues, L.C.

Title:

Estimation of the Impact of the Human Immunodeficiency Virus Infection on Tuberculosis: Tuberculosis Risks Re-visited?

Source:

International Journal on Tubercle and Lung Disease 1(3): 196-204, 1997. (Journal Article: 9 pages)

Abstract:

The human immunodeficiency virus (HIV) infection has both a direct and an indirect effect on the incidence of tuberculosis. The direct effect is due to the increased number of cases among HIV-infected individuals because of their enhanced susceptibility to the disease. The indirect effect is increased transmission of Mycobacterium tuberculosis infection in a community with high levels of dual infection, as a consequence of infectious cases occurring in HIV-infected persons. The risk of infection by M. tuberculosis in the population will then increase, as will the number of tuberculosis cases in the general population. According to the World Health Organization, over 4 million people are estimated to be dually infected with HIV and M. tuberculosis world-wide. In 1990, it was estimated that 300,000 new TB cases (4% of total new cases) were attributable to HIV infection; around 1.4 million cases are expected per year by 2000 (equivalent to about 14% of expected cases), thus increasing the reservoir of tuberculosis patients capable of transmitting the infection to others, and increasing the burden on the already overstretched National Tuberculosis Control Programs, especially in resource-poor countries. This paper is a review of methods suggested to quantify the effect of the interaction between HIV infection and tuberculosis at population level, and more particularly the effect of HIV on the risk of tuberculosis infection. 

Order #: 6913

Authors:

Morrow, R., Fanta, J., Kerlen, S.

Title:

Tuberculosis Screening and Anergy in a Homeless Population.

Source:

Journal of the American Board of Family Practice, 10: 1-5, 1997. (Journal Article: 5 pages)

Abstract:

Tuberculosis has again emerged as a growing public health concern in the United States.  Among the homeless population, increased risk factors contribute to immunodeficiency, which can cause false-negative results on purified protein derivative (tuberculin) (PPD) skin testing, the standard screening procedure for tuberculosis in individuals.  This study evaluates the accuracy of PPD skin test results by determining anergy status of patients when offering the PPD test.  A consecutive convenience sample of 105 underserved men and women were tested at a health clinic located in a homeless shelter in Yonkers, N.Y.  These persons were currently homeless, living in a shelter, or formerly homeless and using the soup kitchen as a shelter. Of the 100 persons who returned for follow-up, 5% were found to be anergic. Of these five, all were previously known to be positive for human immunodeficiency virus (HIV).  Findings concluded that PPD testing alone was found to be an accurate screening test in this population except in those who were HIV positive (authors).