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Volume 19, Number 3—March 2013

CME ACTIVITY - Research

Tuberculosis and HIV Co-infection, California, USA, 1993–2008

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 70% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

Article Title:
Tuberculosis and HIV Co-infection, California, USA, 1993–2008

CME Questions

1. You are a public health consultant to a California HMO, and you are asked to prepare a report regarding tuberculosis (TB)/HIV co-infection. Based on the epidemiological study by Dr. Metcalfe and colleagues, which of the following statements about rates of HIV co-infection among persons with TB and changes in TB incidence among persons with HIV is most likely to appear in your report?

A. About 3% of patients with TB had HIV co-infection

B. Among persons with HIV, overall TB incidence decreased from 437/100,000 in 1993 to 126/100,000 in 2008

C. Rates of TB co-infection increased from 1993 to 2008 among blacks with HIV

D. Rates of TB co-infection increased from 1993 to 2008 among Hispanics with HIV

2. Based on the study by Dr. Metcalfe and colleagues, which of the following statements about characteristics of patients with TB/HIV co-infection in the modern era versus those in the pre-highly active antiretroviral therapy (HAART) era is most likely correct?

A. Compared with the pre-HAART era, patients with TB/HIV in the modern era were less likely to be foreign-born

B. Compared with the pre-HAART era, patients with TB/HIV in the modern era were less likely to be Hispanic

C. Compared with the pre-HAART era, patients with TB/HIV in the modern era were younger

D. Pyrazinamide-monoresistant TB occurred in 8% of patients with TB/HIV in the modern era compared with 2% in the pre-HAART era

3. Based on the study by Dr. Metcalfe and colleagues, which of the following statements about mortality and other characteristics of TB/HIV in California would most likely be correct?

A. Mortality of TB/HIV co-infection decreased from 30% in the pre-HAART era to 14% in the modern era

B. Mortality of TB/HIV is currently 50% higher than in TB patients without HIV

C. Mortality of TB/HIV is currently higher in men than in women

D. Risk factors for mortality in TB/HIV included younger age and men who have sex with men vs heterosexual HIV risk group

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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