Studies target patients’ view of HIV testing

A series of studies in five states may shed light on why TB patients are reluctant to seek HIV testing. The results could change the way HIV counseling and testing is taught to providers, say study researchers.

Earlier this year the Centers for Disease Control and Prevention (CDC) in Atlanta funded studies to evaluate HIV testing among TB patients in five states. Because of the overlap in the two diseases it is important for TB patients to know their TB status, yet acceptance of HIV testing varies from 13% to 80% depending on age race and gender.

The CDC study called for a chart review of patients with active disease or those receiving preventive therapy for TB to identify reasons for not accepting HIV testing. Believing that a quantitative analysis was inadequate, researchers at Johns Hopkins University in Baltimore, one of the grant recipients, are adding a qualitative component as well, says Walt Jones, MPH, project coordinator for the Johns Hopkins University study.

"We didn’t feel like a chart review was going far enough, so we are interviewing not only patients but staff members to see what is getting missed in the communication," he tells TB Monitor.

By conducting more than 100 interviews and 20 focus groups in a five-country area, the researchers hope to identify the barriers to HIV testing among three minority groups — African Americans, Hispanics, and Vietnamese. Among the different age groups, TB patients between 25 and 45 have the lowest HIV testing acceptance. This age group, however, has the highest risk for HIV, says Jones.

While cultural beliefs play a role in HIV testing acceptance, Jones hypothesizes that the way HIV testing is communicated to TB patients may not be effective in the state. Maryland’s HIV counseling and testing training for providers is predominantly patient-centered, and may not adequately emphasize the clinical significance of co-infection with HIV and TB, he says.

"I’m nor sure they realize why it is important for them to get an HIV, especially those on preventive therapy," he says. "They are coming to the clinic because of a private doctor or someone doing a contact investigation. They feel fine and are told to take this medicine and then you add this extra thing about HIV, and it’s like, ‘What is the connection?’"

Matthew Rodieck, MHS, a senior research program coordinator for the Robert Woods Johnson TB Project in Baltimore and co-investigator in the study, agrees that HIV testing training may need to change its emphasis. "It focuses on the trauma and drama of the HIV test and not so much on how to encourage someone to consider the risks they may have in their lives."

He also suspects that timing plays a role, and that offering an HIV test at the same time a patient is being screened or treated for TB may be too much for one visit, he adds.

Another hurdle may be differences between providers and patients. In the Baltimore area, the majority of nurse clinicians are white while most TB patients are black, Jones says.

The researchers are particularly interested in why patients on preventive therapy don’t seek HIV testing, Jones says. While treating active TB in HIV-positive vs. HIV-negative patients doesn’t vary that much (a minimum of six months of therapy), treatment guidelines recommend that HIV-positive patients on preventive therapy receive 12 months of treatment, compared to six months for HIV-negative patients, he adds.