Barriers to human immunodeficiency virus testing of tuberculosis patients in Thailand, 2004-2007

SETTING: Tuberculosis (TB) clinics in five provinces and one national referral hospital in Thailand.OBJECTIVE: To identify risk factors for TB patients not receiving human immunodeficiency virus (HIV) pre-test counseling and testing in Thailand.DESIGN: We collected data on TB patients treated at participating facilities from 2004 to 2007. Patients with known HIV status at the time of TB diagnosis were excluded from the analysis. We performed multivariate logistic regression to determine patient and facility characteristics associated with HIV counseling and testing.RESULTS: Of 15 903 TB patients, HIV pre-test counseling was provided to 13 604 (86%). HIV testing was provided to 11 702 (86%) of those counseled. Of 6141 patients with unknown HIV status, 2323 (38%) were treated in facilities that provide HIV testing in TB clinics compared with 6412 (58%) of 11 003 non-HIV-infected and 3814 (62%) of 6121 HIV-infected patients (P < 0.05). In multivariate analysis, patients treated in facilities in which HIV testing of TB patients was performed somewhere other than the TB clinic were significantly less likely to undergo HIV pre-test counseling (adjusted OR 1.55, 95%CI 1.28-1.86).CONCLUSION: In Thailand, providing HIV testing directly in TB clinics, rather than in other settings, may increase the proportion of TB patients with known HIV status.