1
|
Waddell CJ, Saldana CS, Schoonveld MM, Meehan AA, Lin CK, Butler JC, Mosites E. Infectious Diseases Among People Experiencing Homelessness: A Systematic Review of the Literature in the United States and Canada, 2003-2022. Public Health Rep 2024:333549241228525. [PMID: 38379269 DOI: 10.1177/00333549241228525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness.
Collapse
Affiliation(s)
- Caroline J Waddell
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos S Saldana
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan M Schoonveld
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, US Department of Energy, Oak Ridge, TN, USA
| | - Ashley A Meehan
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina K Lin
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jay C Butler
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
2
|
Gray AT, Surey J, Esmail H, Story A, Harris M. "It's too hard" - the management of latent TB in under-served populations in the UK: a qualitative study. BMC Health Serv Res 2022; 22:1464. [PMID: 36457026 PMCID: PMC9715280 DOI: 10.1186/s12913-022-08855-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND UK national guidance recommends systematic screening for latent tuberculosis infection (LTBI) in under-served populations, including people experiencing homelessness and people who use drugs. This is not routinely implemented in the UK, and the reasons for this policy-practice mismatch remain underexplored. METHODS Semi-structured qualitative interviews were conducted with 19 healthcare professionals from across the UK. Participants were recruited using purposive sampling and snowballing, identifying individuals with excellent knowledge of their regions practice and policy of LTBI management. The interviews were conducted online, and were audio recorded, with transcripts thematically analysed using a two-stage inductive coding process to explore perceived barriers and enablers to LTBI screening. RESULTS Most participants had previous experience managing LTBI in under-served populations, but none were conducting systematic screening as per national guidance. We identified service provision challenges and low prioritisation of LTBI as the key explanatory themes driving this policy-practice mismatch. Lack of resource, and the complexity of clinical decision making were two key service level barriers. System and service inertia, and lack of cost effectiveness evidence led to LTBI being deprioritised. Service integration and promotion of WHO targets for TB elimination were highlighted as potential solutions. CONCLUSION Integrating LTBI testing and treatment with existing health services for under-served populations could improve feasibility and efficacy. Promotion of UK TB elimination goals and generation of regional evidence to support commissioning for LTBI care is vital. Without such a multi-pronged approach inertia is likely to persist and the zeitgeist will remain: "it's too hard".
Collapse
Affiliation(s)
- Adam Thorburn Gray
- Find and Treat, University College London Hospitals, London, UK.
- Hospital for Tropical Diseases, University College London Hospitals, London, UK.
- Institute for Global Health, University College London, London, UK.
| | - Julian Surey
- Find and Treat, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Hanif Esmail
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals, London, UK
- Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
3
|
Chiu TF, Yen MY, Shie YH, Huang HL, Chen CC, Yen YF. Determinants of latent tuberculosis infection and treatment interruption in long-term care facilities: A retrospective cohort study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1310-1317. [PMID: 34686442 DOI: 10.1016/j.jmii.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND/PURPOSE Latent tuberculosis infection (LTBI) treatment is challenging in long-term care facilities (LTCFs) residents due to the occurrence of medical complexities. However, factors associated with treatment interruption have not been extensively studied. This retrospective cohort study aimed to determine LTBI-associated factors and treatment interruption in LTCF residents and employees in Taiwan. METHODS From May 2017 through September 2020, the residents and employees of 20 LTCFs in Taipei, Taiwan, were screened for LTBI by using QuantiFERON-TB Gold In-Tube test. The LTBI individuals underwent directly observed preventive therapy (DOPT), including regimens of 9-month daily isoniazid (9H) and 3-month weekly isoniazid plus rifapentine (3HP). All the LTBI cases were followed up till treatment completion, death, or treatment interruption. RESULTS Among 2207 LTCF subjects, 16.8% had LTBI. After controlling for other covariates, residents of public facilities had a significantly higher LTBI prevalence than those of private facilities (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI]: 1.08-1.88). Among 264 LTBI cases receiving preventive therapy, 52 (19.7%) had treatment interruption. LTBI cases receiving 3HP were less likely to have treatment interruption than those receiving 9H (AOR = 0.22; 95% CI: 0.07-0.71). CONCLUSIONS LTCF residents, particular those living in public facilities, had a high LTBI prevalence. 3HP with DOPT is considered the priority regimen for preventive therapy among LTBI cases in LTCFs.
Collapse
Affiliation(s)
- Ting-Fang Chiu
- Department of Education and Research, Taipei City Hospital, Taiwan; Department of Pediatrics, Taipei City Hospital, Zhongxiao Branch, Taiwan; University of Taipei, Taipei, Taiwan
| | - Muh-Yong Yen
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan; Division of Infectious Diseases, Cheng Hsin General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Huei Shie
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
| | - Hui-Lan Huang
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Education and Research, Taipei City Hospital, Taiwan; University of Taipei, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
4
|
Lee JY, Kwon N, Goo GY, Cho SI. Inadequate housing and pulmonary tuberculosis: a systematic review. BMC Public Health 2022; 22:622. [PMID: 35354400 PMCID: PMC8966856 DOI: 10.1186/s12889-022-12879-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis (TB) is a global health issue that has long threatened and continues to threaten human health. While previous studies are important in the search for a cure for TB, to eradicate the disease it is also crucial to analyze environmental influences. Therefore, this study determined the potential effect of inadequate housing on TB and the magnitude of the effect. Methods This is a systematic review of the effects of inadequate housing on TB. Between Jan 1, 2011 and Oct 25, 2020, we searched four electronic databases using the search terms “housing AND tuberculosis” or “housing AND TB”. The target population comprised residents of inadequate housing and the homeless. Results We found 26 eligible studies. The distribution of the studies across continents was uneven, and the housing issues of interest seemed to vary depending on the economic level of the country. The eight steps identified in TB development and the consequences thereof were more strongly associated with housing affordability than with housing quality. Conclusions This is the first systematic review to identify the effects of inadequate housing on TB and to categorize inadequate-housing-related exposure to TB in terms of affordability and quality. The steps identified in TB development and the consequences thereof had a greater association with housing affordability than with housing quality. Therefore, public health interventions regarding housing affordability could be more diverse, and interventions that support affordable housing for residents of inadequate housing and the homeless should proceed simultaneously to improve housing quality. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12879-6.
Collapse
Affiliation(s)
- Ju-Yeun Lee
- The Department of Public Health, Graduate School of Public Health, Building 220, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Namhee Kwon
- The Department of Health Care Management and Policy, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ga-Yeon Goo
- The Department of Public Administration, Graduate School of Public Administration, Seoul National University, Seoul, Republic of Korea
| | - Sung-Il Cho
- The Department of Public Health, Graduate School of Public Health, Building 220, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea. .,Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Nyamathi A, Morisky D, Wall SA, Yadav K, Shin S, Hall E, Chang AH, White K, Arce N, Parsa T, Salem BE. Nurse-led intervention to decrease drug use among LTBI positive homeless adults. Public Health Nurs 2022; 39:778-787. [PMID: 35014087 DOI: 10.1111/phn.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND People experiencing homelessness (PEH) are disproportionately diagnosed with active tuberculosis. While promoting latent tuberculosis infection (LTBI) treatment has been a call to action, PEH engaging in substance use often experience challenges in completing LTBI treatment. METHODS In this non-randomized single arm study, we tested an innovative, community-based, nurse-led community health worker (RN-CHW) model, on reducing drug use among 50 PEH, residing in homeless shelters or living on the streets in Los Angeles. Follow-up was at 3- and 6- months. RESULTS Findings revealed significant and ongoing decrease in any drug use (odds ratio [OR] = 0.30; 95% confidence interval [CI] = 0.14-0.68); p = .004), amphetamine use (OR = 0.14; 95% CI = 0.02-0.81; p = .029), cannabis use (OR = 0.26; 95% CI = 0.12-0.57; p = .001) and methamphetamine use (OR = 0.30; 95% CI = 0.10-0.90; p = .031) at 6-month follow-up. CONCLUSIONS To our knowledge, this pilot study is the first to evaluate the impact a RN-CHW delivered intervention on reduction in drug use among PEH enrolled in a LTBI intervention. LTBI interventions may serve as an entryway into reduction in drug use among this underserved population.
Collapse
Affiliation(s)
- Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Donald Morisky
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Sarah Akure Wall
- School of Nursing, University of California, Los Angeles, California
| | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Sangshuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California
| | - Elizabeth Hall
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Alicia H Chang
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, California
| | - Kathryn White
- Los Angeles Christian Health Centers, Los Angeles, California
| | - Nicholas Arce
- School of Social Ecology, University of California, Irvine, California
| | - Therese Parsa
- School of Nursing, University of California, Los Angeles, California
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, California
| |
Collapse
|
6
|
Tseng SY, Huang YS, Chang TE, Perng CL, Huang YH. Hepatotoxicity, efficacy and completion rate between 3 months of isoniazid plus rifapentine and 9 months of isoniazid in treating latent tuberculosis infection: A systematic review and meta-analysis. J Chin Med Assoc 2021; 84:993-1000. [PMID: 34747900 DOI: 10.1097/jcma.0000000000000605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The mainstay therapy for latent tuberculosis infection is a 9-month regimen of daily isoniazid (9H) and a 3-month regimen of 12 once-weekly doses of isoniazid and rifapentine (3HP). We performed this updated meta-analysis to compare hepatotoxicity, efficacy and completion rate between these two regimens. METHODS We searched all literature in the major medical databases using the subject search terms "isoniazid" and "rifapentine", and performed a systemic review and meta-analysis. RESULTS A total of 14 studies were eligible for the meta-analysis, which included 5600 (49%) patients who received the 3HP regimen and 5919 (51%) patients who received the 9H regimen. A total of 202 (2%) patients had a drug-induced liver injury (DILI) and 11 317 (98%) did not. The pooled odds ratio (OR) of DILI in the 3HP regimen was 0.18 (95% confidence interval [CI], 0.12-0.26; p < 0.0001), compared with the 9H regimen. This result remained consistent in subgroup analyses of ethnicity and study design. The 3HP regimen was superior to the 9H regimen in the prevention of active tuberculosis (OR, 0.38, 95% CI, 0.18-0.80, p = 0.01). Furthermore, the 3HP regimen was associated with a better completion rate than the 9H regimen (OR: 2.30, 95% CI, 2.10-2.53, p < 0.0001). CONCLUSION The 3HP regimen is superior to the 9H regimen, with less hepatotoxicity, and better efficacy and completion rate in treating latent tuberculosis infection.
Collapse
Affiliation(s)
- Shao-Yu Tseng
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | | | | | | | | |
Collapse
|
7
|
Akamike IC, Okedo-Alex IN, Alo C, Agu AP, Uneke CJ, Ogbonnaya LU. Effect of mobile-phone messaging on patient and health-worker knowledge and adherence to the isoniazid preventive therapy guideline in HIV clinics in Southeast, Nigeria. BMC Infect Dis 2021; 21:1080. [PMID: 34666686 PMCID: PMC8527690 DOI: 10.1186/s12879-021-06759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-infected persons are at increased risk of developing tuberculosis and Isoniazid preventive therapy has been shown to reduce the occurrence of tuberculosis among this group of persons. M-health technology has been reported to increase both knowledge and implementation of various health services including Isoniazid preventive therapy implementation. This study aimed to determine the effect of m-health on health worker knowledge and adherence to isoniazid preventive therapy (IPT) guidelines and on patient knowledge and adherence to isoniazid treatment. METHODS This was a quasi-experimental study that was carried out in six health facilities in Ebonyi State, southeast Nigeria. Three health facilities were assigned to each arm (intervention and control arms) and all eligible health workers (total population of 45 and 41 in intervention and control arms respectively) were recruited. Data were also collected from 200 patients (100 per arm). The intervention consisted of mobile phone messages and reminders for health workers on the IPT guideline. Chi-square test was carried out at p < 0.05 and 95% confidence interval. RESULTS At baseline, 54.5% and 63.4% of health workers in intervention and control arms respectively had good knowledge which improved significantly to 90.2% in the intervention arm after the intervention (χ2 = 14.22, p < 0.0001). At baseline, 61.4% and 90.2% of health workers had good adherence to the guideline in intervention and control arms respectively which also improved in the intervention arm by 28.8% after intervention although not significant(χ2 = 0.37, p = 0.54). More than 50% of the patients in both study arms had poor knowledge, with the intervention arm having a significantly higher proportion of respondents (68.0%) with poor knowledge at baseline (χ2 = 4.71, p = 0.03). The proportion of patients with good knowledge however increased significantly (88.8%) in the intervention arm after intervention (χ2 = 25.65, p < 0.001). Patients had good adherence to IPT in intervention and control arms before (100% and 84.2% respectively) and after (96.6% and 100% respectively) the study. There was no significant difference in adherence among patients in both arms. CONCLUSIONS Health worker knowledge and practice of guidelines as well as patient knowledge improved in the intervention arm in this study. These findings suggest the consideration for the inclusion of mobile phone reminders in the guideline for tuberculosis prevention among HIV patients.
Collapse
Affiliation(s)
- Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria. .,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chihurumnanya Alo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
| | - Adaoha Pearl Agu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Lawrence Ulu Ogbonnaya
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| |
Collapse
|
8
|
Acceptability and Feasibility of a Nurse-Led, Community Health Worker Partnered Latent Tuberculosis Medication Adherence Model for Homeless Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228342. [PMID: 33187301 PMCID: PMC7697464 DOI: 10.3390/ijerph17228342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
Homeless adults are at increased risk of latent tuberculosis infection (LTBI), which can lead to active tuberculosis (TB) disease. The purpose of this study was to assess acceptability and feasibility of a six-month, nurse-led, community health worker-partnered short-course treatment (3HP) LTBI adherence model for a high risk, LTBI positive, homeless population. Informed by our community advisory board (CAB) and community-based participatory research principles (CBPR), a qualitative study was undertaken and used focus group discussions to identify perspectives of homeless men and women who had undergone LTBI treatment (N = 11, Mage = 51.2, SD 8.60, range 35-60). Three themes formed, which were engaging and recruiting LTBI intervention participants, delivering an LTBI intervention, and retaining LTBI intervention participants. Within those themes, barriers (e.g., lack of LTBI treatment readiness, substance use, etc.), and facilitators (e.g., LTBI and TB health education, familiarity with homeless population, etc.) were discussed to facilitate program recruitment, program delivery and program retention. These findings provide a greater understanding of how to effectively utilize a nurse-led, Community Health Worker (CHW) intervention delivery method to not only improve 3HP LTBI medication adherence, but also decrease substance use, improve mental health, and decrease unstable housing among this vulnerable population at high risk for active tuberculosis.
Collapse
|
9
|
Haas MK, Aiona K, Erlandson KM, Belknap RW. Higher Completion Rates with Self-administered Once-weekly Isoniazid-Rifapentine versus Daily Rifampin in Adults with Latent Tuberculosis. Clin Infect Dis 2020; 73:e3459-e3467. [PMID: 32915203 DOI: 10.1093/cid/ciaa1364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment of latent tuberculosis infection (LTBI) is important for tuberculosis (TB) prevention, and short course rifamycin-based therapies are preferred. Once-weekly isoniazid-rifapentine by self-administered therapy (3HP-SAT) has never been compared with four months of daily rifampin (4R). METHODS Retrospective cohort study of adults >18 initiating LTBI treatment with either 3HP-SAT or 4R in a United States (US)-based TB clinic between April 11, 2016-December 31 st, 2018. We evaluated treatment completion through pharmacy fills and reviewed charts for reasons of non-completion, including adverse events. Chi-square tests and a log-binomial multivariable model were used to compare treatment completion and adverse events (AEs). RESULTS 560 individuals (42%) initiated 3HP-SAT and 773 (58%) initiated 4R. Median age was 38, 55% were female, and 89% were born outside of the U.S. Among those aged 18-49, treatment completion with 3HP-SAT was 79% compared to 68% with 4R (adjusted risk ratio (aRR) of 1.17 [95% CI 1.17-1.27, p<0.0001]). Among Individuals aged >=50 years, treatment completion with 3HP-SAT was 87% compared to 64% with 4R (aRR 1.35 [95% CI 1.19-1.52, p<0.0001]). Compared to 4R, there was no difference in risk of AEs in the 18-49 age group (aRR 0.93 [95% CI 1.48-0.75] p=0.75). Reduced risk of AEs was noted among patients aged >=50 who received 3HP-SAT (aRR 0.37 [0.16-0.85] p=0.02). CONCLUSION 3HP-SAT was associated with higher LTBI treatment completion and lower rates of AEs compared to 4R in individuals aged 50 and older. Expanding 3HP-SAT as an option for patients with LTBI may enhance TB prevention strategies in the U.S.
Collapse
Affiliation(s)
- Michelle K Haas
- Denver Health and Hospital Authority, Denver Public Health, Denver, Colorado.,Division of Infectious Diseases, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
| | - Kaylynn Aiona
- Denver Health and Hospital Authority, Denver Public Health, Denver, Colorado
| | - Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado.,Division of Geriatric Medicine, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
| | - Robert W Belknap
- Denver Health and Hospital Authority, Denver Public Health, Denver, Colorado.,Division of Infectious Diseases, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
10
|
Akamike IC, Okedo-Alex IN, Agu AP, Alo C, Ogbonnaya LU. Knowledge and adherence to isoniazid preventive therapy among people living with HIV in multilevel health facilities in South-East, Nigeria: baseline findings from a quasi-experimental study. Pan Afr Med J 2020; 36:261. [PMID: 33014257 PMCID: PMC7519800 DOI: 10.11604/pamj.2020.36.261.22496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction isoniazid preventive therapy is a crucial component of TB/HIV collaborative program and patient good knowledge and adherence to this preventive treatment are essential in improving implementation. The aim of this study was to determine the knowledge and adherence to isoniazid preventive therapy among patients receiving HIV care. Methods this is a baseline result of a quasi-experimental study which was carried out among 200 patients receiving HIV care in six high patient load health facilities providing comprehensive HIV care in Ebonyi State. This included a tertiary health facility and five secondary level health facilities. We used structured interviewer-administered questionnaire to collect information from the participants. Adherence was assessed by self-reports. Descriptive, bivariate and multivariate logistic regression analyses were conducted using SPSS version 20 at 5% level of significance. Results majority (65%) of the respondents were between 30 and 49 years and most (73.5%) were females. Majority (85%) had been on antiretroviral therapy (ART) for more than one year. More than half of the respondents had ever received and had been counselled on IPT (55%, 62% respectively) while only 17.5% were on IPT during the study. More than half (60.5%) of the respondents had low level of knowledge. Marital status was the only predictor of knowledge. Unmarried respondents were 2 times more likely to have knowledge of IPT compared with the married (AOR = 2.11, CI = 1.10-4.06). Among the 35 patients who were on IPT, 32 (91%) reported good adherence in the 30 days preceding the survey. Conclusion: there was poor knowledge of IPT among the respondents however self-reported adherence was high. We recommend intensification of general and personalized education of PLHIV on IPT by health workers.
Collapse
Affiliation(s)
- Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Adaoha Pearl Agu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Chihurumnanya Alo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Lawrence Ulu Ogbonnaya
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| |
Collapse
|
11
|
Jakeman B, Logothetis SJ, Roberts MH, Bachyrycz A, Fortune D, Borrego ME, Ferreira J, Burgos M. Addressing Latent Tuberculosis Infection Treatment Through a Collaborative Care Model With Community Pharmacies and a Health Department. Prev Chronic Dis 2020; 17:E14. [PMID: 32053480 PMCID: PMC7021458 DOI: 10.5888/pcd17.190263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction The objective of this study was to evaluate a novel collaborative care model using community pharmacies as additional access points for latent tuberculosis infection (LTBI) treatment for patients using combination weekly therapy with isoniazid and rifapentine (3HP) plus directly observed therapy for 12 weeks. Methods This prospective pilot study included adult patients diagnosed with LTBI. Patients were eligible for study participation if they spoke English or Spanish and were followed by the New Mexico Department of Health (NM DOH). Patients were excluded if they were pregnant, receiving concomitant HIV antiretroviral therapy, or had contraindications to 3HP due to allergy or drug interactions. Community pharmacy sites included chain, independent, and hospital outpatient pharmacies in Albuquerque and Santa Fe, New Mexico. Results A total of 40 patients initiated treatment with 3HP and were included. Most were female (55%) and had a mean age of 46 years (standard deviation, 12.6 y). A total of 75.0% of patients completed LTBI treatment with 3HP in a community pharmacy site. Individuals of Hispanic ethnicity were more likely to complete treatment (76.7% vs 40.0%, P = .04). Most patients (60%; n = 24) reported experiencing an adverse drug event (ADE) with 3HP therapy. Patients who completed treatment were less likely to experience an ADE than patients who discontinued treatment (50.0% vs 90.0%, P = .03). Pharmacists performed 398 LTBI treatment visits (40 initial visits, 358 follow-up visits), saving the NM DOH approximately 143 hours in patient contact time. Conclusion High completion rates and safe administration of LTBI treatment can be achieved in the community pharmacy setting.
Collapse
Affiliation(s)
- Bernadette Jakeman
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico.,University of New Mexico College of Pharmacy, 1 University of New Mexico, MSC09 5360, Albuquerque, NM 87131. E-mail:
| | - Stefanie J Logothetis
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Melissa H Roberts
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Amy Bachyrycz
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Diana Fortune
- New Mexico Department of Health, Tuberculosis Program, Santa Fe, New Mexico
| | - Matthew E Borrego
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Julianna Ferreira
- New Mexico Department of Health, Tuberculosis Program, Santa Fe, New Mexico
| | - Marcos Burgos
- New Mexico Department of Health, Tuberculosis Program, Santa Fe, New Mexico.,University of New Mexico School of Medicine, Division of Infectious Diseases, Albuquerque, New Mexico.,New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico
| |
Collapse
|
12
|
Onwubiko U, Wall K, Sales RM, Holland DP. Using Directly Observed Therapy (DOT) for latent tuberculosis treatment - A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA. PLoS One 2019; 14:e0218373. [PMID: 31226132 PMCID: PMC6588273 DOI: 10.1371/journal.pone.0218373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/02/2019] [Indexed: 01/06/2023] Open
Abstract
Latent tuberculosis infection (LTBI) treatment in persons at increased risk of disease progression is a key strategy with the strong potential to increase rate of tuberculosis (TB) decline in the United States. However, LTBI treatment in homeless persons, a population at high-risk of active TB disease, is usually associated with poor adherence. We describe the impact of using directly observed treatment (DOT) versus self-administered treatments (SAT) as an adherence-improving intervention to administer four months of daily rifampin regimen for LTBI treatment among homeless adults in Atlanta. Retrospective analysis of clinical care data on 274 homeless persons who initiated daily rifampin treatment for LTBI treatment at a county health department between January 2014 and December 2016 was performed. To reduce bias from non-random assignment of treatment, an inverse probability of treatment weighted (IPTW) logistic regression model was used to assess the effect of treatment type on treatment completion. Subgroup analyses were performed to assess heterogeneity of treatment effect on LTBI completion. Of 274 LTBI treatment initiators, 177 (65%) completed treatment [DOT 118/181 (65%), SAT 59/93 (63%)]. In the fully adjusted and weighted analysis, the odds of completing LTBI treatment on DOT was 40% higher than the odds of completing treatment by SAT [adjusted odds ratio (95% CI), aOR: 1.40 (1.07, 1.82), p = 0.014]. The unstable nature of homeless persons' lifestyle makes LTBI treatment difficult for many reasons. Our study lends support to the use of DOT to improve LTBI treatment completion among subgroups of homeless persons on treatment with daily rifampin.
Collapse
Affiliation(s)
- Udodirim Onwubiko
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, United States of America
| | - Kristin Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rose-Marie Sales
- Tuberculosis Program, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - David P. Holland
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, United States of America
| |
Collapse
|
13
|
Collins JM, Onwubiko U, Holland DP. QuantiFERON-TB Gold Versus Tuberculin Screening and Care Retention Among Persons Experiencing Homelessness: Georgia, 2015-2017. Am J Public Health 2019; 109:1028-1033. [PMID: 31095412 DOI: 10.2105/ajph.2019.305069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To characterize the cascade of care for latent tuberculosis infection (LTBI) in persons experiencing homelessness (PEH) and evaluate the effect of screening by QuantiFERON-TB Gold (QFT) versus tuberculin skin test (TST). Methods. We performed a retrospective cohort study of all PEH screened for LTBI by QFT and TST from May 2015 to April 2017 in Fulton County, Georgia. Results. There were 3504 PEH screened by QFT and 5509 by TST, with 2925 TSTs administered on site at community shelters and 2584 at the health department. More valid test results were obtained in those screened by QFT (99.0% vs 69.0%; P < .001) because of low return rates for reading in both TST arms. For tests administered on site, testing by QFT versus TST improved retention in care with significantly more estimated LTBI cases following up for a medical examination (67.8% vs 51.0%; P < .001) and starting LTBI treatment (58.4% vs 39.8%; P < .001). Conclusions. A QFT-based screening strategy in PEH improved diagnosis and retention in care for new LTBI cases compared with TST and may be an effective strategy to limit progression to active tuberculosis.
Collapse
Affiliation(s)
- Jeffrey M Collins
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - Udodirim Onwubiko
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - David P Holland
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| |
Collapse
|
14
|
Nwana N, Marks SM, Lan E, Chang AH, Holcombe M, Morris SB. Treatment of latent Mycobacterium tuberculosis infection with 12 once weekly directly-observed doses of isoniazid and rifapentine among persons experiencing homelessness. PLoS One 2019; 14:e0213524. [PMID: 30865724 PMCID: PMC6415837 DOI: 10.1371/journal.pone.0213524] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives To investigate treatment outcomes and associated characteristics of persons experiencing homelessness who received 12-weekly doses of directly observed isoniazid and rifapentine (3HP/DOT) treatment for latent TB infection (LTBI). Methods Among homeless persons treated with 3HP/DOT during July 2011 –June 2015 in 11 U.S. TB programs, we conducted descriptive analyses of observational data, and identified associations between sociodemographic factors and treatment outcomes. Qualitative interviews were conducted to understand programmatic experiences. Results Of 393 persons experiencing homelessness (median age: 50 years; range: 13–74 years), 301 (76.6%) completed treatment, 55 (14.0%) were lost to follow-up, 18 (4.6%) stopped because of an adverse event (AE), and 19 (4.8%) stopped after relocations or refusing treatment. Eighty-one (20.6%) had at least one AE. Persons aged ≥65 were more likely to discontinue treatment than persons aged 31–44 years. Programs reported difficulty in following up with persons experiencing homelessness because of relocations, mistrust, and alcohol or drug use. Conclusions This study demonstrates the feasibility of administering the 3HP/DOT LTBI regimen to persons experiencing homelessness, a high-risk population.
Collapse
Affiliation(s)
- Nwabunie Nwana
- ORISE Research Participation Program at Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Suzanne M Marks
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward Lan
- Los Angeles County Department of Public Health Tuberculosis Control Program, Los Angeles, California, United States of America
| | - Alicia H Chang
- Los Angeles County Department of Public Health Tuberculosis Control Program, Los Angeles, California, United States of America
| | - Michael Holcombe
- Mississippi State Department of Health Tuberculosis Program, Jackson, Mississippi, United States of America
| | - Sapna Bamrah Morris
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
15
|
Sun HY, Huang YW, Huang WC, Chang LY, Chan PC, Chuang YC, Ruan SY, Wang JY, Wang JT. Twelve-dose weekly rifapentine plus isoniazid for latent tuberculosis infection: A multicentre randomised controlled trial in Taiwan. Tuberculosis (Edinb) 2018; 111:121-126. [PMID: 30029896 DOI: 10.1016/j.tube.2018.05.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/06/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Abstract
Treatment of latent tuberculosis (TB) infection (LTBI) effectively prevents its progression to active TB. However, long treatment duration and drug-related hepatotoxicity limit the effectiveness of the 9-month daily isoniazid (9H). Data on the 3-month weekly rifapentine plus isoniazid (3 HP) in Asian populations are currently unavailable. We prospectively randomised the LTBI contacts aged ≥12 years with positive tuberculin skin test into 9H and 3 HP groups in four hospitals between January 2014 and May 2016 in Taiwan. The primary and secondary outcomes were treatment completion rate and adverse drug reactions (ADRs), respectively. Overall, 263 participants with LTBI were randomised into the 3 HP (n = 132) and 9H groups (n = 131); 14 (10.6%) and 29 (22.1%) participants in the 3 HP and 9H groups, respectively, discontinued therapy (p = 0.011). Discontinuation rates owing to ADRs were 9.1% (3 HP) and 5.3% (9H) (p = 0.241). Clinically relevant hepatotoxicity was more common in the 9H than in the 3 HP group (5.3% vs. 1.5%; p = 0.103), whereas systemic drug reaction was more common in the 3 HP than in the 9H group (3.8% vs. 0%; p = 0.060). Women had a significantly higher rate of Grade II fever than men (13.7% vs. 1.2%; p = 0.003). Compared with the 9H regimen, the 3 HP regimen had a higher completion rate with lower hepatotoxicity and well-tolerated ADR. CLINICAL TRIALS REGISTRATION number NCT02208427.
Collapse
Affiliation(s)
- Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Wen Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Pulmonary and Critical Care Unit, Changhua Hospital, Department of Health, Changhua, Taiwan
| | - Wei-Chang Huang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan; Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, 407, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, 407, Taiwan
| | - Lih-Yu Chang
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Pei-Chun Chan
- Department of Pediatrics, National Taiwan University Hospital and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
16
|
Pease C, Hutton B, Yazdi F, Wolfe D, Hamel C, Barbeau P, Skidmore B, Alvarez GG. A systematic review of adverse events of rifapentine and isoniazid compared to other treatments for latent tuberculosis infection. Pharmacoepidemiol Drug Saf 2018; 27:557-566. [DOI: 10.1002/pds.4423] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/19/2017] [Accepted: 02/19/2018] [Indexed: 01/07/2023]
Affiliation(s)
| | - Brian Hutton
- Ottawa Hospital Research Institute; Ottawa Canada
- Public Health and Preventive Medicine; Ottawa University School of Epidemiology; Ottawa Canada
| | | | - Dianna Wolfe
- Ottawa Hospital Research Institute; Ottawa Canada
| | | | | | | | - Gonzalo G. Alvarez
- Ottawa Hospital; Ottawa Canada
- Ottawa Hospital Research Institute; Ottawa Canada
- Ottawa University Faculty of Medicine; Ottawa Canada
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Mycobacterium tuberculosis (M.tb), the etiologic agent of tuberculosis, is a prominent global health threat because of the enormous reservoir of subclinical latent tuberculosis infection (LTBI). Current diagnostic approaches are limited in their ability to predict reactivation risk and LTBI is recalcitrant to antibiotic treatment. The present review summarizes recent advances in our ability to detect, treat and model LTBI as well as our understanding of bacterial physiology during latency. RECENT FINDINGS T-cell subsets and circulating proteins have been identified which could serve as biomarkers for LTBI or indicators of reactivation risk. In addition, experimental and in-silico models have enabled discoveries regarding bacterial physiology during latency and the host immune response following infection with latent M.tb. SUMMARY Despite recent advances, much more research is needed to bolster our ability to detect, implement treatment and model LTBI. The present work is crucial for the eradication of this global problem.
Collapse
|
18
|
Reddy D, Walker J, White LF, Brandeis GH, Russell ML, Horsburgh CR, Hochberg NS. Latent Tuberculosis Infection Testing Practices in Long-Term Care Facilities, Boston, Massachusetts. J Am Geriatr Soc 2017; 65:1145-1151. [PMID: 28467605 DOI: 10.1111/jgs.14696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe latent tuberculosis infection (LTBI) testing practices in long-term care facilities (LTCFs). DESIGN Retrospective cohort study. SETTING Three Boston-area LTCFs. PARTICIPANTS Residents admitted between January 1 and December 31, 2011. MEASUREMENTS Resident demographic characteristics, comorbidities, LTCF stay, and LTBI testing and treatment. RESULTS Data for 291 LTCF residents admitted in 2011 were reviewed. Of the 257 without a history of LTBI and with documentation of testing, 162 (63%) were tested; 114 of 186 (61%) with a stay less than 90 days and 48 of 71 (68%) with a stay of 90 days or longer were tested. Of 196 residents with data on prior LTBI testing, 39 (19.9%) had LTBI; 12 of these (30.8%) were diagnosed at the LTCF. Hispanic participants were more likely than black participants to undergo LTBI testing (adjusted odds ratio (aOR) = 2.4, P = .003). Having a length of stay of less than 90 days (aOR = 0.7, P < .001) and history of illicit drug use (aOR = 0.7, P < .001) were associated with lower odds of LTBI testing. CONCLUSION One-fifth of LTCF residents had LTBI, but testing was not always performed. The high prevalence of LTBI in older adults combined with the risk of an outbreak if a case of tuberculosis occurs in a LTCF make LTBI testing and treatment an important prevention opportunity. The importance of LTBI testing in LTCFs needs to be reinforced.
Collapse
Affiliation(s)
- Divya Reddy
- Section of Pulmonary, Allergy, Sleep and Critical Care, Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Jacob Walker
- School of Medicine, Boston University, Boston, Massachusetts
| | - Laura F White
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Gary H Brandeis
- Section of Geriatric Medicine, Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Matthew L Russell
- Section of Geriatric Medicine, Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Charles R Horsburgh
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.,Section of Infectious Diseases, Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Natasha S Hochberg
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.,Section of Infectious Diseases, Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| |
Collapse
|