SettingFive health care systems in Texas.ObjectiveTo describe the epidemiology of inadequate isolation for pulmonary tuberculosis leading to tuberculosis (TB) exposures from confirmed TB patients and the patient factors that led to the exposures.DesignA retrospective cohort and case-control study of adult patients with TB resulting in exposures (cases) vs those TB patients who did not result in exposures (controls) during January 2005 to December 2012.ResultsThere were 335 patients with pulmonary TB disease, 199 cases and 136 controls. There was no difference between groups in age (46 ± 14.6 vs 45 ± 17 years; P > .05), race, or substance abuse. Cases were more likely to be transplant recipients (adjusted odds ratio [AOR], 18.90; 95% CI, 1.9–187.76), have typical TB chest radiograph (AOR, 2.23; 95% CI, 1.1–4.51), and have positive acid-fast bacilli stains (AOR, 2.36; 95% CI, 1.31–4.27). Cases were less likely to have extrapulmonary disease (AOR, 0.47; 95% CI, 0.24–0.95).ConclusionsTB exposure resulting from inadequate isolation is frequent in health care settings. Extrapulmonary involvement resulted in earlier airborne isolation. Being a transplant recipient, having chest radiograph findings typical for TB, and sputum positivity acid-fast bacilli upon staining were associated with increased risk of inadequate isolation.
BackgroundHIV-related stigma is a leading barrier to engagement in HIV care and successful treatment. Disclosure Stigma (DS), the fear of disclosing one’s serostatus, is associated with poor adherence and retention in care, but its association with clinical indicators of HIV treatment is not well established. The purpose of this study was to determine the influence of DS on virologic suppression, and our hypothesis was that DS would be associated with lack of virologic suppression.MethodsThis cross-sectional study was performed between May 2015 and February 2016, at the largest publicly funded HIV clinic in South Texas. A survey was administered to consecutively recruited participants at routine follow-up who were: ≥18-years-old, HIV+, and receiving antiretroviral therapy. Surveys included demographics, sexual/HIV history, AIDS Clinical Trials Group baseline adherence questionnaire, and a validated HIV-stigma scale. Clinical data were obtained from medical records. The primary predictor was DS: the sum of 10 items ranked 0–4, with maximum score of 30 indicating highest stigma. The primary outcome was lack of virologic suppression (LOVS): most recent HIV-1 RNA>20 copies/mL. Bivariate analyses were conducted to examine: (i) predictors of DS and (ii) predictors of LOVS. Multivariate logistic regression models examined the relationship between DS and LOVS.ResultsFor 275 participants, median DS score was 18.5 (IQR 13, 23). In bivariate analysis, depression (OR 1.10; CI 1.05, 1.15) and perceived stress (OR 1.04; CI 1.01, 1.08) were significantly associated with increased DS. However, dissatisfaction with help received by friends/family was associated with reduced odds of DS (OR 0.46; CI 0.27, 0.78). DS was significantly inversely associated with LOVS (OR 0.96; CI 0.92, 0.99) and age (OR 0.97; CI 0.95, 0.998), and positively associated with drug use (OR 3.96; CI 1.53, 10.23). The association between DS and LOVS was maintained after adjusting for age, gender/sexual orientation, race/ethnicity, and drug use.ConclusionDS was highly prevalent in this cohort. The unanticipated inverse association between DS and LOVS highlights the complexity of this relationship. Despite this association, the balance of data in this cohort demonstrates an overall negative impact of DS. Further study is needed to understand this surprising finding.Disclosures All authors: No reported disclosures.
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