HIV testing rates and co-infection among patients with tuberculosis in south-eastern Sydney, 2008-2013

Objective: To evaluate the rate of HIV and tuberculosis co-infection and changes in HIV testing practices for patients with tuberculosis managed in South Eastern Sydney Local Health District (SESLHD), New South Wales, Australia. Design, participants and setting: A retrospective review of tuberculosis notification data from four public tuberculosis treatment clinics in SESLHD (population, > 800 000), 2008-2013. Data were extracted from the NSW Notifiable Conditions Information Management System. Intervention: Published evidence regarding clinical management of HIV and tuberculosis co-infection and feedback of HIV testing rates was provided to senior clinicians managing tuberculosis in SESLHD between 2008 and 2012. Main outcome measures: Proportion of patients with tuberculosis with HIV infection status ascertained and proportion with HIV co-infection. Results: Of 506 people with notified tuberculosis treated in SESLHD during the study period, 369 had their HIV status ascertained (72.9%), of whom 20 were HIV co-infected (5.4%). Eleven of these cases were new HIV diagnoses. Seven people offered an HIV test declined the offer. The rates of HIV co-infection varied between clinics (1.5%-9.7%; P = 0.02) as did the rate of HIV status ascertainment (61.5%-85.4%; P < 0.001). The rate of HIV status ascertainment increased between 2008 and 2013 (52.9%-87.1%; P < 0.001). Conclusions: The rate of HIV co-infection among people treated for tuberculosis in south-eastern Sydney is of clinical importance. Rates of HIV testing in this population have increased, but further gains are desirable. It is unclear if the intervention influenced the increase in HIV testing rates.