Integrated counseling and screening for tuberculosis and HIV among household contacts of tuberculosis patients in an endemic area of HIV infection: Chiang Rai, Thailand

SETTING: Combined hospital-based and home visit, Chiang Rai, Thailand. OBJECTIVE: To describe the results of screening of tuberculosis (TB) and HIV infection among household contacts of TB patients in an area endemic for HIV. DESIGN: Consecutive new smear-positive TB patients were interviewed and their household contacts were screened for TB including tuberculin skin test (TST), chest radiography, and sputum examination. Voluntary HIV testing and counseling was also performed. RESULTS: Of 499 pulmonary TB index cases, 197 (39.5%) were HIV-positive; 1200 household contacts were screened for TB and 890 (74.2%) agreed to HIV testing. The prevalence of TST induration greater than or equal to10 mm and active TB among household contacts of HIV-positive pulmonary TB cases were 46.2% (225/487) and 2.9% (14/490), and among household contacts of HTV-negative TB cases were 62.1% (438/705) and 4.4% (31/710), respectively. Higher HIV prevalence was found among contacts of HIV-positive TB patients than among household contacts of HIV-negative TB index cases (52/376, 13.8% vs. 13/514, 2.5%) (P < 0.001). Spouses of HIV-positive TB cases had the highest HIV prevalence (36/ 74, 48.6%). Among the household contacts who were HIV-positive, 9.5% (7/74) had active TB. CONCLUSION: Integrated counseling and screening for TB and HIV should be provided for household contacts of TB patients in an HIV endemic area.