Tuberculosis screening and treatment compliance in human immunodeficiency virus patients

This study aims to evaluate compliance of HIV patients to TB screening and treatment, identifying determinants for non-compliance. We reviewed clinical records of all HIV infected patients first attended in a Portuguese-Infectious-Unit from 2007-2010 (152 patients). Screening included: symptom inquiry, chest x-ray, TST/IGRA. In 2008 a protocol was established with a TB outpatient clinic allowing patients to choose where to perform screening (decentralization). All patients were offered screening, 69 (45.4%) accepted. Before decentralization, out of 78 patients, 20 (25%) accepted screening. After decentralization, out of 64 patients, 49 (76.6%) accepted screening. Decentralization was associated with higher levels of acceptance (p<0.001), having an AIDS-defining-disease (p=0.002) and being older (p=0.04) was associated with lower screening acceptance. LTBI was diagnosed in 14 and active-TB in 18 cases; 14 cases of active-TB were later diagnosed during hospital appointments. For active-TB, being on HAART was related with treatment adherence (p=0.03). In this population, improving health care access was important for screening compliance.