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Tang AS, Mochizuki T, Dong Z, Flood J, Katrak SS. Can Primary Care Drive Tuberculosis Elimination? Increasing Latent Tuberculosis Infection Testing and Treatment Initiation at a Community Health Center with a Large Non-U.S.-born Population. J Immigr Minor Health 2023:10.1007/s10903-022-01438-1. [PMID: 36652151 PMCID: PMC9847435 DOI: 10.1007/s10903-022-01438-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/19/2023]
Abstract
Community health centers (CHC) play a key role in latent tuberculosis infection (LTBI) testing and treatment. We performed a retrospective analysis of LTBI testing and treatment among pediatric and adult patients at a CHC with a large non-U.S.-born (USB) population during a series of quality improvement (QI) interventions from 2010 to 2019. Among 124,695 patients with primary care visits, 40% of patients were tested for tuberculosis (TB) infection and among those tested, 20% tested positive, including 39% of adults aged 50-79 years. Compared to adults aged 18-49 years, children aged 6-17 had increased odds of LTBI testing and treatment initiation [odds ratio and 95% confidence interval 3.23 (3.10, 3.36) and 1.41 (1.12, 1.79), respectively], while age ≥ 65 was associated with lower odds of both testing and treatment initiation. Over the analysis period, coinciding with unfunded QI interventions intended to reduce barriers to LTBI care, there was a significant increase in the proportion of patients receiving LTBI testing for both adults (6% to 47%, p < 0.001) and children (23% to 80%, p < 0.001). During the analysis period, there was also a significant increase in the proportion of patients receiving prescriptions for LTBI treatment, as well as provider use of evidence-based strategies including rifamycin-based treatment. Our study suggests that primary care interventions can reduce barriers to LTBI treatment and drive TB elimination.
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Affiliation(s)
- Amy S. Tang
- North East Medical Services, 1520 Stockton St., San Francisco, CA 94133 USA
| | - Tessa Mochizuki
- grid.236815.b0000 0004 0442 6631Tuberculosis Control Branch, California Department of Public Health, Richmond, CA USA
| | - Zinnia Dong
- North East Medical Services, 1520 Stockton St., San Francisco, CA 94133 USA
| | - Jennifer Flood
- grid.236815.b0000 0004 0442 6631Tuberculosis Control Branch, California Department of Public Health, Richmond, CA USA
| | - Shereen S. Katrak
- grid.236815.b0000 0004 0442 6631Tuberculosis Control Branch, California Department of Public Health, Richmond, CA USA ,grid.266102.10000 0001 2297 6811Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA USA
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Holzman SB, Perry A, Saleeb P, Pyan A, Keh C, Salcedo K, Narita M, Ahmed A, Miller TL, Pettit AC, Khurana R, Whipple M, Katz D, Largen A, Krueger A, Shah M. Evaluation of the Latent Tuberculosis Care Cascade Among Public Health Clinics in the United States. Clin Infect Dis 2022; 75:1792-1799. [PMID: 35363249 PMCID: PMC11075804 DOI: 10.1093/cid/ciac248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) elimination within the United States will require scaling up TB preventive services. Many public health departments offer care for latent tuberculosis infection (LTBI), although gaps in the LTBI care cascade are not well quantified. An understanding of these gaps will be required to design targeted public health interventions. METHODS We conducted a cohort study through the Tuberculosis Epidemiologic Studies Consortium (TBESC) within 15 local health department (LHD) TB clinics across the United States. Data were abstracted on individuals receiving LTBI care during 2016-2017 through chart review. Our primary objective was to quantify the LTBI care cascade, beginning with LTBI testing and extending through treatment completion. RESULTS Among 23 885 participants tested by LHDs, 46% (11 009) were male with a median age of 31 (interquartile range [IQR] 20-46). A median of 35% of participants were US-born at each site (IQR 11-78). Overall, 16 689 (70%) received a tuberculin skin test (TST), 6993 (29%) received a Quantiferon (QFT), and 1934 (8%) received a T-SPOT.TB; 5% (1190) had more than one test. Among those tested, 2877 (12%) had at least one positive test result (3% among US-born, and 23% among non-US-born, P < .01). Of 2515 (11%) of the total participants diagnosed with LTBI, 1073 (42%) initiated therapy, of whom 817 (76%) completed treatment (32% of those with LTBI diagnosis). CONCLUSIONS Significant gaps were identified along the LTBI care cascade, with less than half of individuals diagnosed with LTBI initiating therapy. Further research is needed to better characterize the factors impeding LTBI diagnosis, treatment initiation, and treatment completion.
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Affiliation(s)
- Samuel B Holzman
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Allison Perry
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Paul Saleeb
- Maryland Department of Health and Hygiene, Baltimore, Maryland, USA
| | - Alexandra Pyan
- Maryland Department of Health and Hygiene, Baltimore, Maryland, USA
| | - Chris Keh
- Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Tuberculosis Control Branch, Richmond, California, USA
| | - Katya Salcedo
- Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Tuberculosis Control Branch, Richmond, California, USA
| | - Masahiro Narita
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Amina Ahmed
- Pediatric Infectious Disease and Immunology, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Thaddeus L Miller
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Renuka Khurana
- Maricopa County Department of Public Health, Phoenix, Arizona, USA
| | | | - Dolly Katz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Amy Krueger
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maunank Shah
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York, USA
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Oxlade O, den Boon S, Menzies D, Falzon D, Lane MY, Kanchar A, Zignol M, Matteelli A. TB preventive treatment in high- and intermediate-incidence countries: research needs for scale-up. Int J Tuberc Lung Dis 2021; 25:823-831. [PMID: 34615579 DOI: 10.5588/ijtld.21.0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND: In 2018, the WHO Member States committed to providing TB preventive treatment (TPT) to at least 30 million people by 2022. However, only 6.3 million people had initiated TPT by the end of 2019. Major knowledge gaps and research needs in diagnosis, treatment and the programmatic management of TPT (PMTPT) require to be addressed urgently.METHODS: In September 2019, a group of stakeholders involved in PMTPT in high TB burden countries met to develop an action agenda to support the global expansion of PMTPT.RESULTS: Barriers at the health system level, and priorities for research to overcome these, were identified for each step of the PMTPT cascade. The need for data on TPT financing, gaps and coverage under national health insurance schemes, as well as the need for mathematical and cost-effectiveness modelling of the impact of TPT on TB incidence and mortality were highlighted. Specific research needs were identified for high-risk populations such as household contacts of any age and people living with HIV, as well as other people at risk.CONCLUSIONS: The meeting facilitated agreement on a set of actions needed to ensure that PMTPT continues to expand to achieve the End TB Strategy targets.
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Affiliation(s)
- O Oxlade
- McGill International TB Centre, Montreal, QC, Canada
| | - S den Boon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - D Menzies
- McGill International TB Centre, Montreal, QC, Canada, McGill University, Montreal, QC, Canada
| | - D Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - M Y Lane
- McGill International TB Centre, Montreal, QC, Canada, McGill University, Montreal, QC, Canada
| | - A Kanchar
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - M Zignol
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - A Matteelli
- WHO Collaborating Centre for TB/HIV co-infection and for TB Elimination Strategy, University of Brescia, Brescia, Italy
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Souza AB, Arriaga MB, Amorim G, Araújo-Pereira M, Nogueira BMF, Queiroz ATL, Figueiredo MC, Rocha MS, Benjamin A, Moreira ASR, Oliveira JG, Rolla V, Durovni B, Lapa E Silva JR, Kritski AL, Cavalcante S, Sterling T, Andrade BB, Cordeiro-Santos M. Determinants of losses in the latent tuberculosis infection cascade of care in Brazil. BMJ Glob Health 2021; 6:bmjgh-2021-005969. [PMID: 34518204 PMCID: PMC8438757 DOI: 10.1136/bmjgh-2021-005969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/21/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil. METHODS Close contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6-24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade. RESULTS Among 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/pardo (brown) race were independently associated with losses in the cascade. CONCLUSION There were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.
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Affiliation(s)
- Alexandra Brito Souza
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Manaus, AM, Brazil
| | - María B Arriaga
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Betânia M F Nogueira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, BA, Brazil
| | - Artur T L Queiroz
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Center of Data and Knowledge Integration for Health (CIDACS),Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | - Marina C Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michael S Rocha
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, BA, Brazil
| | - Aline Benjamin
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Adriana S R Moreira
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jamile G Oliveira
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valeria Rolla
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José R Lapa E Silva
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Solange Cavalcante
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil.,Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Timothy Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil .,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Manaus, AM, Brazil.,Faculdade de Medicina, Universidade Nilton Lins, Manaus, AM, Brazil
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