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The Impact of HIV Infection on TB Disparities Among US-Born Black and White Tuberculosis Patients in the United States

Marks, Suzanne M. MPH, MA; Katz, Dolly J. PhD; Davidow, Amy L. PhD; Pagaoa, Melissa A. MPH; Teeter, Larry D. PhD; Graviss, Edward A. PhD, MPH, FIDSA

Journal of Public Health Management and Practice: February 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000949
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Background/Objectives: US-born non-Hispanic black persons (blacks) (12% of the US population) accounted for 41% of HIV diagnoses during 2008-2014. HIV infection significantly increases TB and TB-related mortality. TB rate ratios were 6 to 7 times as high in blacks versus US-born non-Hispanic whites (whites) during 2013-2016. We analyzed a sample of black and white TB patients to assess the impact of HIV infection on TB racial disparities.

Methods: In total, 552 black and white TB patients with known HIV/AIDS status were recruited from 10 US sites in 2009-2010. We abstracted data from the National TB Surveillance System, medical records, and death certificates and interviewed 477 patients. We estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for associations of TB with HIV infection, late HIV diagnosis (≤3 months before or any time after TB diagnosis), and mortality during TB treatment.

Results: Twenty-one percent of the sample had HIV/AIDS infection. Blacks (AOR = 3.4; 95% CI, 1.7-6.8) and persons with recent homelessness (AOR = 2.5; 95% CI, 1.5-4.3) had greater odds of HIV infection than others. The majority of HIV-infected/TB patients were diagnosed with HIV infection 3 months or less before (57%) or after (4%) TB diagnosis. Among HIV-infected/TB patients, blacks had similar percentages to whites (61% vs 57%) of late HIV diagnosis. Twenty-five percent of HIV-infected/TB patients died, 38% prior to TB diagnosis and 62% during TB treatment. Blacks did not have significantly greater odds of TB-related mortality than whites (AOR = 1.1; 95% CI, 0.6-2.1).

Conclusions: Black TB patients had greater HIV prevalence than whites. While mortality was associated with HIV infection, it was not significantly associated with black or white race.

US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia (Mss Marks and Pagaoa and Dr Katz); New Jersey Medical School at Rutgers, Newark, New Jersey (Dr Davidow); Forensic Research and Analysis, Lake Oswego, Oregon (Dr Teeter); and Houston Methodist Research Institute, Houston, Texas (Dr Graviss).

Correspondence: Suzanne M. Marks, MPH, MA, or Dolores J. Katz, PhD, US Centers for Disease Control and Prevention, Mailstop E-10, 1600 Clifton Rd, Atlanta, GA 30333 (SMARKS@CDC.GOV) or (DDK4@CDC.GOV).

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors declare no conflicts of interest.

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